Areas of Multidimensional Assessment
What does it mean to assess someone? Assessment makes it possible to describe the behavior or other characteristics of people in meaningful ways (Stoner, O’Riley, & Edelstein, 2009). Assessment is a formal process of measuring, understanding, and predicting behavior. It involves gathering medical, psychological, and sociocultural information about people through various means, such as interviews, observation, tests, and clinical examinations.
As we noted in Chapter 1, two central aspects of any assessment approach are reliability and validity. Without these psychometric properties, we cannot rely on the assessment method to provide good information. In addition, any assessment method must be of practical use in determining the nature of the problem and choosing the appropriate treatment.
A multidimensional assessment approach is most effective (Stoner et al., 2009; Zarit & Zarit, 2006). Multidimensional assessment often is done by a team of professionals; for example, a physician may examine the medication regimen; a psychologist,
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A thorough assessment of physical health is an essential part of a comprehensive mental health assessment.
the cognitive functioning; a nurse, the daily living skills; and a social worker, the economic and environmental resources. Let’s consider Juan’s situation as an example.
A thorough assessment of Juan’s physical health is essential, as it is for adults of all ages, especially for older adults. Many physical conditions can create (or hide) mental health problems, so it is important to identify any underlying issues. Laboratory tests can also be ordered that can provide additional clues to the presence or even the cause of the problem.
Establishing Juan’s cognitive ability is also key. Complaints of cognitive problems increase across adulthood, so it is important to determine the extent to which abnormal changes in older people are discriminated from normative change. Adults of all ages can be given intelligence tests, neuropsychological examinations, and mental status examinations. Mental status exams are especially useful as quick screening measures of mental competence that are used to screen for cognitive impairment; one commonly used instrument, the Mini Mental Status Exam (MMSE), is shown in Table 10.1. If Juan’s score on these brief measures indicated potential problems, more complete follow-up assessments would be used. It is important to remember that scales such as the MMSE are only used for general screening and not for final diagnosis.
Psychological functioning typically is assessed through interviews, observation, and tests or questionnaires. Usually a clinician begins with an interview of Juan and brief screening instruments and follows up, if necessary, with more thorough personality inventories, tests, or more detailed interviews.
How well Juan functions in his daily life is also assessed carefully. Usually this entails determining whether he has difficulty with activities of daily living and instrumental activities of daily living (see Chapter 4). Also assessed is the person’s decision-making capacity; each state has legal standards guiding the competency assessment.
Social factors in Juan’s life such as social support constitute the final area of assessment. Rook,
A Sampling of Questions from the Mini Mental Status Exam
Cognitive Area Activity
Orientation to “What is the date?”
“Listen carefully. I am going to say three words. You say them back after I say them. Ready? Here they are. . . APPLE [pause], PENNY [pause], TABLE [pause]. Now repeat those words back to me.” [Repeat up to 5 times, but score only the first trial.]
“What is this?” [Point to a pencil or pen.]
Reading stimulus “Please read this and do what it form says.” [Show examinee the words
on the form.]
CLOSE YOUR EYES
Source: Reproduced by special permission of the Publisher, Psychological Assessment Resources, Inc., 16204 North Florida Avenue, Lutz, Florida 33549, from the Mini Mental Status Examination, by Marshal Folstein and Susan Folstein. Copyright 1975, 1998, 2001 by Mini Mental LLC,
Inc. Published 2001 by Psychological Assessment Resources, Inc. Further reproduction is prohibited without permission of PAR, Inc. The MMSE can be purchased from PAR, Inc., by calling (813) 968-3003.
Mavandadi, Sorkin, and Zettel (2007) describe three dimensions of social functioning: ties with one’s social network, the content of interactions with members of the social network, and the number and quality of interactions with network members. Addressing all areas of Juan’s physical, cognitive, psychological, and social functioning will help determine whether Rocio has reason to be concerned. Most important, social functioning and social networking provide a major resource for health and well-being.
the assessment process (Stoner et al., 2009). Two areas of concern are biases (negative or positive) and environmental conditions (where the assessment occurs, sensory or mobility problems, and health of the client).
Many types of bias have been documented as affecting the assessment process (Stoner et al.,
2009) . Negative biases about people are widespread and include racial, ethnic, and age stereotypes. For example, clinicians may hold negative biases against younger adults of ethnic minorities and more readily “diagnose” problems that do not truly exist. Likewise, because of ageism, older adults may be “diagnosed” with untreatable problems such as Alzheimer’s disease rather than treatable problems such as depression (see Chapter 1). In contrast, positive biases about certain people also work against accurate assessment. For example, a belief that women do not abuse alcohol may result in a misdiagnosis; beliefs that older adults are “cute” may mitigate against accurate assessment of abilities. Clearly, the best defense against bias is for clinicians to be fully educated about their prospective clients.
The environmental conditions in which the assessment occurs can also work against accurate outcomes. Clinicians do not always have the option of selecting an ideal environment; rather, assessments sometimes occur in hallways, with a bedridden patient, or in a noisy emergency room. People with sensory or motor difficulties must be accommodated with alternative assessment formats. The patient’s physical health may also complicate assessment; in many cases with older adults, it can also create a negative bias in that mental health issues may be overlooked when a health problem is discovered (Qualls & Benight, 2007).
Taken together, clinical assessment is an excellent example of how the forces of development come together. Only when all four forces are considered can mental health problems be assessed accurately.