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CASPARS: Clinical
Assessment Package for
Assessing Client Risks &
Strengths



        Jane F. Gilgun, Ph.D., LICSW
      Professor, School of Social Work,
   University of Minnesota, Twin Cities, USA

              jgilgun@umn.edu
Topics
   Assessment 101
   The CASPARS
   The 4-D
   Case Studies
   Customizing Tools
Significance
   Practice effectiveness
   Accountability
   Brief treatment
   Evidence-based practice
       Best research evidence
       Clinical experience
       Client preferences, wants, cultures
       Practitioners’ personal experiences, values,
        cultures
   Ethical codes
Purposes of the Instruments
   direct attention to positives
   lead to helpful assessments
   help formulate treatment plans
   help estimate progress in treatment
   provide a check on countertransference
   provide measures of outcome
   provide data that demonstrates effects of
    treatment
Concepts of the Instruments
   Assets are Significant in Models of Risk
   Adding Assets to Risk Models Increases
    Accuracy of Classification
   Assets Alone in Models of Risks May be as
    Accurate as Risk Alone Models
   Assets, Risks, and Protective Factors Reside
    Within Individuals, Families, Other Social
       Groups, Communities, Social Policies,
    and Cultural Themes and Practices.
   Asset Models Require Shifts in Thinking
Assets
    Assets are positive counterparts of risk that
    can contribute to pro-social outcomes when
    individuals are exposed to risks.
   Assets include factors such as high IQ,
    physical attractiveness, verbal facility, parents
    who care, safe neighborhoods, adequate
    family income, a pro-social sense of agency,
    optimism about a positive future
    Not all persons with assets turn out well, nor
    do all persons from poor families and unsafe
    neighborhoods have maladaptive outcomes
Risks
   Risks predict that a proportion of an at-risk
    group will experience adverse outcomes.
   Persons with risks are vulnerable to an
    associated outcome, but risks cannot predict
    that any one person in an at-risk group will
    experience that outcome
   Risks include childhood maltreatment, unsafe
    neighborhoods, isolated families, exposure to
    persons who model violent behaviors, genetic
    risks such as those predisposing persons to
    particular types of physiological reactivity
    Individuals in an at-risk group, however, are
    vulnerable to that outcome.
Risk Pile-Up
   a series of risks that may
      overwhelm whatever resources an

       individual can marshall

       or in some cases persons appear to
        have the resources to cope.
Protective Factors
assets individuals actively use
 to cope with

 adapt to, or

overcome vulnerability-inducing
  conditions, or risks
Protective Factors
   Pro-social sense of agency
   Desire to emulate persons who are pro-social
   Have avenues open to them where they can
    attain a sense of self that includes self-
    efficacy and self-worth
       These avenues do not harm self or others
   Emotional expressiveness
   Affirmative relationships
   Healthy sexuality
   Sense of belonging to a pro-social group
   Strong sense of positive future
       Resources to attain future goals
Resilience
   Definition: positive outcomes when
    individuals have been exposed to risks
   Resilience means a person has risk
    conditions and therefore has
    vulnerabilities
   Persons can be
       Resilient at one point and not at others
       Resilient in some areas and not in others
CASPARS

   Emotional expressiveness
   Family Relationships
   Peer Relationships
   Family Embeddedness
   Sexuality
Scoring the CASPARS
   Each instrument yields two scores: An asset
    score and a risk score
   Scores for each instrument are attained by
    summing each column
   Children can be classified by using scores
    from single instruments
   Children can be classified using scores
    resulting from the sums of scores
    of all the instruments for a global score
Scoring the CASPARS
   1=low strength or low risk
   2=medium strength or medium risk
   3=high strength or high risk
   0=not observed or unknown
The 4-D

 Belonging

  Mastery
 Independence

 Generosity
Scoring the 4-D
   Each instrument yields two scores: An asset
    score and a risk score
   Scores for each instrument are attained by
    summing each column
   Children can be classified by using scores
    from single instruments
   Children can be classified using scores
    resulting from the sums of scores
    of all the instruments for a global score
Scoring the 4-D
   1=mixed
   2=low strength or low risk
   3=medium strength or medium risk
   4=high strength or high risk
Relationship of Assets & Risks
          Over the Course of Intervention
40


30


20


10


 0
     T1                  T2                 T3

                     Assets   Risks
Clinical Assessment
Tools
   Short, easy to use
   Useful to practice
   Provide scores
   Not the same as tools used in
    psychological and educational testing
   Provide practice guidelines
       When they are based on research &
        practice experience
Types of Assessments

   Unsystematic

   Systematic but idiosyncratic

   Systematic and shared
Systematic, Shared Asessments
   Can coordinate practice across cases,
    within agencies, and across agencies

   Provide practice guidelines

   Help standardize practice

   Provide clear identity for the agency
Each Case is Unique

   General, Agency-Wide Assessment

   Individualized goals, outcomes, and
    interventions
The CASPARS: Sources of
Concepts
   My reflections on the factors
    associated with resilience
         Factors extracted from
            My long-term life history research

             (primary)
            Integrated with

                social work’s ecological

                 perspectives
               
                 Research on risk and resilience
Sources of Items: 4-D
   Circle of Courage
   Related research and theory
   Experience of social work professionals
    and one clinical psychologist
   My life history research
Sources of Items: CASPARS
   Primary: My life history research
   Backed up with
       Related research and theory
       Experience of two social work
        professionals and two clinical
        psychologists
Stetson School Assessment
   Responsibility
   Honesty
   Motivation for treatment
   Remorse

   Developed by Phil Rich, Barre, MA, USA
   1/978/355-4541
Capacities for Accountability
    What do the young people say about their
    problematic sexual behaviours?
       Can they describe them?
       Take responsibility for them?
       Recognize harm done?
       Are they willing to apologize?
       Are they willing to work on managing these behaviours?

     This is a strengths-based approached because such
    questions are asking the young people to tap into
    their competencies.
Capacities for Accountability
   Appropriate vs. flat affect in talking about their
    behaviours
   Take responsibility vs. blame others
   Remorse vs. “blowing off”
       Signaled by
            I’m sorry I hurt others.
            I feel ashamed. Does the child appear to have these
             responses but need help in articulating them?

    How can practitioners do assessments that provide
    children with a sense of safety so that children can
    show their deep shame, embarrassment, guilt, and
    remorse, which we can assume is almost always
    there?
Field Tests
   CASPARS
       25 professionals
       1 state
       N=146
   4-D
       25 professionals
       4 states
       N=118
The CASPARS
   Content Validity
   Item-Total Analysis
   Coefficient Alpha
   Inter-Rater Reliabilities
   Construct Validities
Item-Total Analysis
           Means
Emo Peer Fam Rel Fam Emb Sex
.76 .63.80      .78   .67



Note: none below .50
Alphas & IRR
             # Items   Alphas   IRR
   Emo        14      .94      .92
   Peer       16      .90      .93
   FamRel     20      .97      .93
   Embed      13      .96      .92
   Sex        13      .90      .95
Construct Validities
             R
   Emo      -.56
   Peer     -.80
   FamRel   -.81
   Embed    -.82
   Sex      .46
The 4-D
   Content Validity
   Item-Total Analysis
   Coefficient Alpha
   Interviewing
Results of Item-Total Analysis

Instrument # of Items #
 Below .5
 Belonging      12          1
 Mastery        18          2
 Independence         9         1
 Generosity       9         0
Results: Coefficient Alphas


          Initial   Eliminate   Final
Belonging    .87        Q8      .89
Knowing      .93       Q2 & 2   .93
Independence .87        Q4      .91
Generosity   .91        0       .91
Results: Standard Errors
  of Measurement

          Expected     Actual

Belonging    5.5      5.62
Mastery      9.5      7.16
Independence 4.0      8.84
Generosity   4.5      4.87
Total       11.94     11.75
Interviews with Users
   Usefulness the most important criteria
    for the worth of practice tools

   Find out instruments’ usefulness
    through discussions with users
Interviews with Users
   Individually
       Phone
       Email
       In-person
       Group in-Person
            Minnesota staff
            South Carolina staff
       Informational interviews in person
         
             South Carolina social workers and care providers
Responses to the Field Test:
Summary
   Positive responses
       Helped me know youth in a new way
       Led to one of the best conversations I’ve
        ever had
   Areas for improvement
       Too long
       Too intrusive, such as the questions on
        sexuality
       Don’t fit practice
References
       Brendtro, Larry K., Martin Brokenleg, & Steven Van Bockern (1990). Reclaiming
youth at risk: Our hope for the future. Bloomington, IN: National Educational Service
       Gilgun, Jane F. (2003). The 4-D: Strengths-based instruments for the assessment of
youth who’ve experienced adversities. Submitted for publication.
       Gilgun, Jane F. (2002a). Completing the Circle: American Indian Medicine Wheels
and the promotion of resilience in children and youth in care. Journal of Human Behavior
and the Social Environment, 6(2), 65-84.
       Gilgun, Jane F. (1999b). CASPARS: New tools for assessing client risks and
strengths. Families in Society, 80, 450-459. tools available at
ssw.che.umn.edu/faculty/jgilgun.htm
       Gilgun, Jane F., Susan Keskinen, Danette Jones Marti, & Kay Rice. (1999). Clinical
applications of the CASPARS instruments: Boys who act out sexually . Families in Society,
80, 629-641.
       Levitt, J. L., & Reid, W., J. (1981). Rapid-assessment instruments for practice.
Social Work Research and Abstracts, 17, 13-19.
       Schafer M. (1999) Nomothetic and idiographic methodology in psychiatry: A
historical-philosophical analysis. Medicine, Health Care & Philosophy, 2(3):265-74.

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The CASPARS: A Child & Family Assessment

  • 1. CASPARS: Clinical Assessment Package for Assessing Client Risks & Strengths Jane F. Gilgun, Ph.D., LICSW Professor, School of Social Work, University of Minnesota, Twin Cities, USA jgilgun@umn.edu
  • 2. Topics  Assessment 101  The CASPARS  The 4-D  Case Studies  Customizing Tools
  • 3. Significance  Practice effectiveness  Accountability  Brief treatment  Evidence-based practice  Best research evidence  Clinical experience  Client preferences, wants, cultures  Practitioners’ personal experiences, values, cultures  Ethical codes
  • 4. Purposes of the Instruments  direct attention to positives  lead to helpful assessments  help formulate treatment plans  help estimate progress in treatment  provide a check on countertransference  provide measures of outcome  provide data that demonstrates effects of treatment
  • 5. Concepts of the Instruments  Assets are Significant in Models of Risk  Adding Assets to Risk Models Increases Accuracy of Classification  Assets Alone in Models of Risks May be as Accurate as Risk Alone Models  Assets, Risks, and Protective Factors Reside Within Individuals, Families, Other Social Groups, Communities, Social Policies, and Cultural Themes and Practices.  Asset Models Require Shifts in Thinking
  • 6. Assets  Assets are positive counterparts of risk that can contribute to pro-social outcomes when individuals are exposed to risks.  Assets include factors such as high IQ, physical attractiveness, verbal facility, parents who care, safe neighborhoods, adequate family income, a pro-social sense of agency, optimism about a positive future  Not all persons with assets turn out well, nor do all persons from poor families and unsafe neighborhoods have maladaptive outcomes
  • 7. Risks  Risks predict that a proportion of an at-risk group will experience adverse outcomes.  Persons with risks are vulnerable to an associated outcome, but risks cannot predict that any one person in an at-risk group will experience that outcome  Risks include childhood maltreatment, unsafe neighborhoods, isolated families, exposure to persons who model violent behaviors, genetic risks such as those predisposing persons to particular types of physiological reactivity Individuals in an at-risk group, however, are vulnerable to that outcome.
  • 8. Risk Pile-Up  a series of risks that may  overwhelm whatever resources an individual can marshall  or in some cases persons appear to have the resources to cope.
  • 9. Protective Factors assets individuals actively use  to cope with  adapt to, or overcome vulnerability-inducing conditions, or risks
  • 10. Protective Factors  Pro-social sense of agency  Desire to emulate persons who are pro-social  Have avenues open to them where they can attain a sense of self that includes self- efficacy and self-worth  These avenues do not harm self or others  Emotional expressiveness  Affirmative relationships  Healthy sexuality  Sense of belonging to a pro-social group  Strong sense of positive future  Resources to attain future goals
  • 11. Resilience  Definition: positive outcomes when individuals have been exposed to risks  Resilience means a person has risk conditions and therefore has vulnerabilities  Persons can be  Resilient at one point and not at others  Resilient in some areas and not in others
  • 12. CASPARS  Emotional expressiveness  Family Relationships  Peer Relationships  Family Embeddedness  Sexuality
  • 13. Scoring the CASPARS  Each instrument yields two scores: An asset score and a risk score  Scores for each instrument are attained by summing each column  Children can be classified by using scores from single instruments  Children can be classified using scores resulting from the sums of scores of all the instruments for a global score
  • 14. Scoring the CASPARS  1=low strength or low risk  2=medium strength or medium risk  3=high strength or high risk  0=not observed or unknown
  • 15. The 4-D  Belonging  Mastery  Independence  Generosity
  • 16. Scoring the 4-D  Each instrument yields two scores: An asset score and a risk score  Scores for each instrument are attained by summing each column  Children can be classified by using scores from single instruments  Children can be classified using scores resulting from the sums of scores of all the instruments for a global score
  • 17. Scoring the 4-D  1=mixed  2=low strength or low risk  3=medium strength or medium risk  4=high strength or high risk
  • 18. Relationship of Assets & Risks Over the Course of Intervention 40 30 20 10 0 T1 T2 T3 Assets Risks
  • 19. Clinical Assessment Tools  Short, easy to use  Useful to practice  Provide scores  Not the same as tools used in psychological and educational testing  Provide practice guidelines  When they are based on research & practice experience
  • 20. Types of Assessments  Unsystematic  Systematic but idiosyncratic  Systematic and shared
  • 21. Systematic, Shared Asessments  Can coordinate practice across cases, within agencies, and across agencies  Provide practice guidelines  Help standardize practice  Provide clear identity for the agency
  • 22. Each Case is Unique  General, Agency-Wide Assessment  Individualized goals, outcomes, and interventions
  • 23. The CASPARS: Sources of Concepts  My reflections on the factors associated with resilience  Factors extracted from  My long-term life history research (primary)  Integrated with  social work’s ecological perspectives  Research on risk and resilience
  • 24. Sources of Items: 4-D  Circle of Courage  Related research and theory  Experience of social work professionals and one clinical psychologist  My life history research
  • 25. Sources of Items: CASPARS  Primary: My life history research  Backed up with  Related research and theory  Experience of two social work professionals and two clinical psychologists
  • 26. Stetson School Assessment  Responsibility  Honesty  Motivation for treatment  Remorse  Developed by Phil Rich, Barre, MA, USA  1/978/355-4541
  • 27. Capacities for Accountability  What do the young people say about their problematic sexual behaviours?  Can they describe them?  Take responsibility for them?  Recognize harm done?  Are they willing to apologize?  Are they willing to work on managing these behaviours?  This is a strengths-based approached because such questions are asking the young people to tap into their competencies.
  • 28. Capacities for Accountability  Appropriate vs. flat affect in talking about their behaviours  Take responsibility vs. blame others  Remorse vs. “blowing off”  Signaled by  I’m sorry I hurt others.  I feel ashamed. Does the child appear to have these responses but need help in articulating them?  How can practitioners do assessments that provide children with a sense of safety so that children can show their deep shame, embarrassment, guilt, and remorse, which we can assume is almost always there?
  • 29. Field Tests  CASPARS  25 professionals  1 state  N=146  4-D  25 professionals  4 states  N=118
  • 30. The CASPARS  Content Validity  Item-Total Analysis  Coefficient Alpha  Inter-Rater Reliabilities  Construct Validities
  • 31. Item-Total Analysis Means Emo Peer Fam Rel Fam Emb Sex .76 .63.80 .78 .67 Note: none below .50
  • 32. Alphas & IRR # Items Alphas IRR  Emo 14 .94 .92  Peer 16 .90 .93  FamRel 20 .97 .93  Embed 13 .96 .92  Sex 13 .90 .95
  • 33. Construct Validities R  Emo -.56  Peer -.80  FamRel -.81  Embed -.82  Sex .46
  • 34. The 4-D  Content Validity  Item-Total Analysis  Coefficient Alpha  Interviewing
  • 35. Results of Item-Total Analysis Instrument # of Items # Below .5 Belonging 12 1 Mastery 18 2 Independence 9 1 Generosity 9 0
  • 36. Results: Coefficient Alphas Initial Eliminate Final Belonging .87 Q8 .89 Knowing .93 Q2 & 2 .93 Independence .87 Q4 .91 Generosity .91 0 .91
  • 37. Results: Standard Errors of Measurement Expected Actual Belonging 5.5 5.62 Mastery 9.5 7.16 Independence 4.0 8.84 Generosity 4.5 4.87 Total 11.94 11.75
  • 38. Interviews with Users  Usefulness the most important criteria for the worth of practice tools  Find out instruments’ usefulness through discussions with users
  • 39. Interviews with Users  Individually  Phone  Email  In-person  Group in-Person  Minnesota staff  South Carolina staff  Informational interviews in person  South Carolina social workers and care providers
  • 40. Responses to the Field Test: Summary  Positive responses  Helped me know youth in a new way  Led to one of the best conversations I’ve ever had  Areas for improvement  Too long  Too intrusive, such as the questions on sexuality  Don’t fit practice
  • 41. References Brendtro, Larry K., Martin Brokenleg, & Steven Van Bockern (1990). Reclaiming youth at risk: Our hope for the future. Bloomington, IN: National Educational Service Gilgun, Jane F. (2003). The 4-D: Strengths-based instruments for the assessment of youth who’ve experienced adversities. Submitted for publication. Gilgun, Jane F. (2002a). Completing the Circle: American Indian Medicine Wheels and the promotion of resilience in children and youth in care. Journal of Human Behavior and the Social Environment, 6(2), 65-84. Gilgun, Jane F. (1999b). CASPARS: New tools for assessing client risks and strengths. Families in Society, 80, 450-459. tools available at ssw.che.umn.edu/faculty/jgilgun.htm Gilgun, Jane F., Susan Keskinen, Danette Jones Marti, & Kay Rice. (1999). Clinical applications of the CASPARS instruments: Boys who act out sexually . Families in Society, 80, 629-641. Levitt, J. L., & Reid, W., J. (1981). Rapid-assessment instruments for practice. Social Work Research and Abstracts, 17, 13-19. Schafer M. (1999) Nomothetic and idiographic methodology in psychiatry: A historical-philosophical analysis. Medicine, Health Care & Philosophy, 2(3):265-74.