The Purpose and Importance of Clinical Assessment in Mental Health Settings
There are numerous forms of assessments that are engaging with purpose, importance, effectiveness in clinical settings. Clinical assessments provide a medical professional with reason, emotions, and insight into a client’s thinking process. An assessment will provide a given look at the overall mental capacity in which a patient is working. The scope of intellectual, emotional, and social operational picture can provide a score of information in determining the functionality of a client. Through assessment, we can identify potential mental conditions and disorders that may be prevalent in the client. Anxiety, schizophrenia, depression, bipolar disorders are all considered genetically hereditary obtained and reinforced through epigenetic factors of environmental placement. Through genetic testing and assessment, a physician can make a sound determination of mental capacity. This emphasizes the importance of assessments in the psychological arena. Mental health assessments often include an in-person interview depending upon what stage you are at in the process of assessment. Typically during the interview, a total person approach is taken, where your family history is discussed (mental and physical health); thoughts, feelings, and behaviors; length in which symptoms that are affecting the patient have to exist; major life events (death, divorce); the frequency of symptoms and occurrence of each; substance abuse or prescription medication; support elements (religious, family); childhood history. In addition to interviewing a patient, additional forms of assessment may be conducted. The client may need to take an intellectual test “Norm-Referenced Test” is one such form of intellectual test. It measures your abilities against your peers and provides feedback in the form of a percentage. If 100 individuals take the test and you score a 30 you would be at the 30th percentile for that group. Other specialized assessments may take a look at remembrance, reasoning, and activities. Another factor in devising assessments is cultural implications. Each cultural background holds specific value in determining a viable assessment. An example of this could be if the Center for Disease Control determined that a male that consumed 15 drinks in a one-week setting may be seen as a heavy drinker. Granted this may have been determined by a biological assessment of alcohol on the body that issued this conclusion, one’s culture may disagree with it. In Germany alcohol is persistent in the environment and seems to be treated with responsibility in their culture. Some may see 15 drinks in a one-week setting as mild or as low drinking habits. This may cause them to reject the Center for Disease Control’s conclusion on heavy drinking for males. This demonstrates why an assessment must look at cultural settings and conditions to determine what the Norms of the group are. Without the backing of Mental or Social Norm, it is less likely that an assessment can be performed accurately or at least with some degree of latitude that the assessment will hold up to the potential diagnosis that
The interview portion of the assessment provides an ample amount of information to garden from the client. It can be conducted in three formats. Structured, semi-structured, and unstructured. Structured interviews cover information that is set in a rigid format to assess if a client meets the symptom requirements for mental disorders covered in the DSM-V. Questions are given verbatim to the client to assure the accuracy of the results. Variations of this form of interviewing are composite international diagnostic, diagnostic interview schedule, diagnostic interview schedule for children, structured interview for PTSD, and substance use disorders diagnostic schedule. Semi-structured interviews are not as formal and the previously mentioned process. This method provides the counselor the ability to encourage the client to expand upon their answers. Questions can be asked in different ways for better understanding and information expansion. A popular method of conducting a semi-interview is the structured clinical interview for DSM-IV, Schedule for affective disorders, schizophrenia, and diagnostic interview for children and adolescents-IV. The most widely used interview method is the unstructured interview process. There is no particular standardization of the question record of the response. In this method, the psychologist creates the questions and per-determines the proper answers for how to gauge the proper response. In this assessment similar to the others the therapist will collect family history, social history, medical history, substance abuse, and the three areas of clients problems (Onset, Severity, Stressor) (Iwata, Wong, Riordan, Dorsey, & Lau, 1982)
Cultural implications in building a valid assessment hold considerable weight in determining the potential outcome and future diagnosis from an assessment. Depending upon where you reside within the globe, your nationality settings, gender, age, race, and ethnicity, religion, a client will have a different set of Norm standards. If you reside in a western national model, historical old world, or communism will determine how the culture reacts at a macro level. In addition, religion has a major effect on the culture at micro and macro levels across the world. Each religion is specific in its virtues and functionalities. Each maintains various practices of faith in similar and vastly different ways. For this reason, religion has an influence on one’s culture. If we look at the Mild East, nearly all nations have a majority of Muslim-based faith (History.com Editors, 2018; Iwata et al., 1982). If we narrow the scope in this region of the world we can determine that each part of the middle east breaks down the Islam faith into smaller sects. Sunnis and Shiites become the two major sub-sects of this particular faith. Each breaking off from the original teaching of Muhammad thus creating a subculture within the main religious culture. This demonstrates even further the importance of tailoring an assessment to the client’s cultural boundaries. In the United States, cultural implications represent a more difficult strenuous task of individualized assessment that is geared towards the client. America from its foundation was the influx of immigrants from western Europe (England, France, Dutch, Etc) all of which fled for religious reasons creating a series of mini religious cultures that were outside of the traditional Catholic or Church of England model that had existed (“History of Immigration in the US | USAFacts,” n.d.). Next came the migrations of Eastern Europe and Asia. This in turn brought about the expansion of the cultural influence of their homeland to America. Throughout the History of the United States, we have absorbed a diversified set of cultures in our community at large and small levels and settings. This has often led to America being referred to as the melting pot. Due to this melting pot status that has been formed from a conglomerate of cultures and a subset of cultures it provides a therapist a unique set of challenges in selecting and tailoring assessment that can be measured against a reference point or setting. Broad traditional reference measurement can be used but neglect to allow an individual to gauge against a set of peers that represent their cultural identity. This can be potentially problematic for the American Psychologist. However, educational standards have advanced in the degree process that challenges an individual to become more diverse in their educational background by encouraging cultural overview. By considering involvement in the cultural background we can assure a proper diagnosis.
The use of family history plays an important factor as a part of the assessment. Family history, if known provide a wealth of Mental and Physical information that can aid the assessor in determining a diagnosis. There are a few components that are gathered in the intake of a client’s history. Physically, if plausible genetic testing for the major mental health disorder that has been proven to pass down the family hierarchy may be needed. Though the test in itself does not determine if the client has mental health issues, it does enable the assessor to see the probability of the potential outcome of a diagnosis. Anxiety, depression, bipolar, and schizophrenia are all linked to various genomes that are passed through family history. Additionally, environmental factors and settings can affect new or pasted down genomes through epigenetics. As a client, that experiences life, whether abuse, poverty, etc, these experiences are absorbed into the body altering the mental and physical standpoint of the client. Another concept of genetic implication in assessment can be transgenerational trauma. This is where the experience of a person subjected to a significant amount of trauma and through the epigenetic process is absorbed into the body and passed down to the next generation (Alarcón, 2009; “[No title],” n.d.-a). This theory came about after a clinical review of multiple children born to holocaust survivors who develop symptoms of what we now call Post Traumatic Stress Disorder. The signs and symptoms were often related to the experience that their parents felt and describe during the encampment. In this theory, the trauma is directly passed to the immediate offspring, with the potential to carry further down the family line. Exploration could be conducted into other aspects of diverse cultural trauma to include various People across the globe, Prisoner of War Camps, Combat Action, and various other forms of mass trauma (“[No title],” n.d.-b). Physical health factors such as heart attack, diabetes, stroke, and diseases can play a large part in determining the family’s overall health and potential lifestyle (Carson, Katz, Gao, & Alegría, 2010). Physical health can play a role in one’s mental health. This aids the therapist in determining if physical factors are playing a role in the mental illness of the patient, it also allowed for the therapist to seek out medications that may play a factor in the reduction of physical and mental health abilities like physical family history a look at mental health down the family can indicate risk factors that may be associated with various mental disorders.
Department of Health, & Human Services. (n.d.). Assessments and evaluations for mental illness treatment. Retrieved October 21, 2019, from https://www.betterhealth.vic.gov.au:443/health/servicesandsupport/assessments-and-evaluations-for-mental-illness-treatment
Iwata, B. A., Wong, S. E., Riordan, M. M., Dorsey, M. F., & Lau, M. M. (1982). Assessment and training of clinical interviewing skills: analogue analysis and field replication. Journal of Applied Behavior Analysis, 15(2), 191.