Assignment 18 complete on Frank…. Frank’s information below:

A description of the content for each of the main sections of your report follows:

Identification and Referral

·         Client’s name, age, marital status, ethnicity, gender.

·          Describe the setting, including where the testing took place, how the  client travelled there (or if you went to the client’s home), if he or  she was on time and accompanied by anyone.

·          Reason for testing at this time, including the referral source (can be a  self-referral or a fictitious referrer) and the information sought by  the referrer.

·         Presenting problems and symptoms.

There  should be one or more referral questions to be answered by your  assessment.  These questions will be answered in your “Recommendations”  section and the answers should flow logically from your findings.   Some  common referral questions for psychological testing include:

·         Mental health diagnosis and treatment or management recommendations.

·         Disability determination – whether the client is able to work and limitations.

·         Vocational/educational assessment – what kind of work would be a good fit for the client’s abilities.

·          Learning disability assessment – is a learning disability present and  what sort of limitations and accommodations are appropriate.

History

Preface your history by indicating the source (such as client’s report or family report) and whether you feel it is reliable.

Family History.  Include information about current family, current living situation and family of origin.

Educational and Vocational History.   Level of education completed, high school and college grades, any  history of special education, expulsions and suspensions, occupation and  jobs held, last worked, reason for any dismissals, longest time at the  same job, vocational aspirations if relevant.

Medical and Mental Health History.   The non-psychiatric section should include reports of medical diagnoses  and symptoms, current medications, surgeries and overnight  hospitalizations, and head injuries.  The mental health section should  include psychiatric hospitalizations, outpatient mental health  treatment, substance abuse treatment, history of psychotropic medication  prescriptions, and suicide attempts.  When applicable, indicate that  there was “no reported history of …” to show that you inquired about the  areas above.

Antisocial Behavior/Substance Abuse.   Age, charge, and outcome of any arrests or other legal problems.   Current and past use of alcohol and other recreational drugs, 12-step  group attendance.

Daily Functioning

Client’s  mode of travel (car, bus, family rides) and ability (short trips by  car, uses the bus but needs help to get to a new location, etc.).   Client’s daily living skills, including ability to groom, bathe, dress,  do household chores, and manage money.  Include a general description of  the client’s daily activities including job, recreational, and social  activities.

Review of Records

Include  a brief summary of educational or medical records if available (or  indicate that no records were available when the report was completed).   Diagnoses and test scores are often particularly helpful, as they  provide a baseline for comparison.  Records reviewed should include  report dates, institution name, and the name of the physician or other  professional.

Mental Status and Behavioral Observations

Use  the Mental Status Exam form as a guide for your interview.  This  section can be written or dictated directly from this form.

General appearance:  Particularly note unusual characteristics that may provide diagnostic  information – neglected hygiene, usual dress or tattoos, or physical  characteristics that may affect the person’s social interactions and  abilities.

Attitude & general behavior: Describe the person’s interaction with you and attitude toward being tested and interviewed.

Mood and affect:  Obtain a quote from the client regarding recent mood.  Ask about any  history of depression and anxiety.  Note the range of the client’s  affect.  Ask about sleep and appetite, and inquire further about  depressive or anxious symptoms if a particular disorder if suspected.   See the symptom guide at the bottom of the MSE form.  For instance, if  PTSD were suspected, you would inquire about symptoms such as  nightmares, flashbacks, and startle response.

Stream of mental activity:  Most clients will be described as responding in a coherent and relevant  fashion and speaking at a normal pace with 100% intelligibility.  Note  any deviations from this, including psychotic symptoms, slower or faster  than normal speech, and problems with speech intelligibility.  Note  unusual speech content and inquire into delusional thinking (paranoid,  reference, control, grandiosity) if psychosis is suspected.

Sensorium and orientation:  You will describe most clients as alert and aware of their  surroundings; note any deviations from this.  Orientation includes  awareness of elements such as person, place, time and situation.  Do not  say the client was “oriented times three” as the meaning of this is not  always consistent and clear.  Do report the questions you asked and the  client’s responses.  For instance, “The client reported the current day  of the week as Saturday rather than Monday.”

Memory.   Use simple tests to assess the client’s long- and short-term memory and  report the results of those tests.  A useful test of short-term memory  is to list three objects, have the client repeat them back, and then ask  the client to recall them after five minutes have passed.

Fund of information.   Two or three questions will give a rough index of the client’s general  knowledge.  Easy (mental retardation suspected): “How many legs on a  dog?” or “Where is your nose?”, Average: “How many days in a year?”,  Above average: “What is the boiling temperature of water?”

 Concentration and attention:  Rate the client’s ability to attend to instructions and task  persistence.  Simple concentration tasks are counting backwards from 20  or, for higher functioning clients, counting backwards from 100 by 7.   Note the time required and number of errors.  If ADHD is suspected, use  the symptom guide at the bottom of the MSE form to inquire further about  symptoms.

Perceptual distortions:  Ask about any history of auditory or visual hallucinations and  determine if they were associated with drug use or mood (mania or  depression).  If there were hallucinations, note their frequency, when  they last occurred, and their content.  Note if the client appears to be  responding to hallucinations.

Judgment & insight.   Use a simple, standard question to test judgment, such as “What would  you do if your neighbor’s house were on fire?”  Also, note any history  that would indicate impaired judgment, such as arrests or job  dismissals.  Insight is whether the client has an accurate understanding  of his or her mental health status.  If there are mental health  problems, a client with good insight attributes symptoms to these  problems, and is aware of the need for treatment.  For instance, a man  diagnosed as schizophrenic would demonstrate good insight if he  understands that his auditory hallucinations are caused by his illness  and that psychiatric medication would help.  An alcoholic demonstrates  good insight if she admits her illness and recognizes the need to attend  AA or other treatment.

Test Results

When  discussing the WAIS-IV results, be sure to include a discussion of the  Full Scale Intelligence Quotient (FSIQ), Verbal Comprehension Index  (VCI) and Perceptual Reasoning Index (PRI), Working Memory Index (WMI)  and Processing Speed Index. You will need to discuss the client’s  strengths and weaknesses with regard to subtest variability.

Refer  to the WAIS-IV PowerPoint and the sample report as a guide.  Start with  the FSIQ, indicate its percentile range and category (Low Average,  Superior, etc.).  If a change in functioning is suspected due to head  injury or other problem, compare the FSIQ to estimated pre-morbid  functioning.

Compare  the VCI to the PRI, and indicate if they are significantly different.   Briefly interpret this comparison.  If they are not significantly  different you can say, “The VCI and PRI were not significantly different  from each other, reflecting about equal facility with tasks requiring  words as with tasks requiring non-verbal reasoning and performance.”  If  they are significantly different, indicate why you think this is.  Is  it consistent with a suspected diagnosis?  Does it reflect cultural  differences or a physical impairment?

When  discussing the WRAT4 results, be sure to include a discussion of the  WRAT4 scores.  Present the Standard Scores and Percentile ranks for each  subtest of the WRAT4 (Word Reading, Spelling, Sentence Comprehension,  Math Computation). You also want to talk about scores that are out of  the normal range and what that might suggest.  It is helpful to give  examples of the client’s abilities, particularly on Math Computation  (i.e., “able to perform arithmetic operations with whole numbers, but  unable to work with decimals or fractions”).  If a WRAT4 subtest differs  significantly from IQ (at least 20 points lower), a diagnosis of  learning disorder is likely, unless you feel that the difference is  better explained by other factors.

When  discussing the MMPI-2 results, be sure to include a discussion of the  validity scales (you can refer to your text for further guidance). Then  interpret/discuss the clinical scales that are clinically significant,  which are a T-score of 65 or greater. Your text and the powerpoint of  the MMPI-2 (found under the course resources tab) list interpretive  paragraphs of such scores.

When  discussing the MCMI-III results, be sure to include a discussion of the  validity scales, which can be assessed by noting the pattern of scores  of the validity indicators (you can refer to your text for further  guidance). Then interpret/discuss the Personality Disorder Scales that  are clinically significant. Note that a BR score of 75-84 suggests the  syndrome or pattern is present, whereas scores of 85 or above indicate  that it is prominent. Next, interpret/discuss the Clinical Syndrome  Scales. Your text lists interpretive paragraphs of such scores.

Diagnostic Impressions

Provide a complete DSM-5 diagnosis to include the WHODAS 2.0 (p. 747 on the DSM-5).   Your diagnoses should be clearly supported by the material you have  presented to this point.  Your assessment is very likely the most  thorough psychodiagnostic procedure the client will ever undergo, so it  is important that you come to a decision and not expect that another  clinician will be better able to do this.

Summary 

·          This section should not introduce any new information. It needs to  integrate and present an overall picture of the client, in regards to  the referral question.

·         Statement of overall level of functioning, symptoms present, and problems experienced

·         What is the level of cognitive functioning and capacities

Recommendations

·          The most significant and pressing problem should be listed first and  should be in the context of the referral question.

·          Do not make recommendations about issues that are outside the purview  of your training and competency.  For instance, you would not recommend  an imaging study or a specific medication.  You might recommend referral  to a neurologist or psychiatrist for evaluation and possible treatment.

·          Make recommendations that take practical and financial limitations into  account.  It may be tempting to recommend “further testing” because you  feel unsure of your recommendations.  But keep in mind that testing can  be expensive and time consuming.  Additional testing should only be  recommended if it is for a specific purpose and is necessary for  important decision-making.

As much as possible, your recommendations should take your test  findings into account and should answer questions that could not have  been answered before the assessment was done.  You do not need to  suggest that the client see a physician because she reported occasional  headaches.

Vignette

Read

(B) Chapter 4 Confidentiality, Privilege and Privacy pp. 159-213 and HIPAA, pp. 543-545.

 

(F) Chapter 7 Standards on Privacy and Confidentiality pp. 190-203; and review Preface pp. xxi-xxxvi.

 

Vignette

 

Please read the vignette below and respond to it via the assignment submission link by Day Six. You MUST apply an appropriate ethical decision making model from Bersoff or apply another ethical decision making model which you may prefer (e.g., Canadian Psychological Association; NASP, etc.). Use the steps of the decision making model to discuss your decision making process.

 

Tell Tale Vignette

 

Maria is a 32 year old, Latina. Her child, Rosalinda, age 6, was referred to counseling after having been exposed to domestic violence (Maria reports having been the victim) in the home.

 

Maria is separated from Rosalinda’s father who is the alleged perpetrator in the domestic violence.

 

When Maria brought Rosalinda to her first evaluation session (symptoms included: nightmares, regression, easily moved to tears, clingy with Maria), Maria read and signed an informed consent form while in the waiting room. The form was fairly standard issue, citing all the usual exceptions to confidentiality. The psychology intern properly introduced herself to Maria and briefly went over the informed consent. Maria expressed understanding of and agreement with the evaluation and treatment for her daughter.

 

Maria was the principal informant during the assessment, and the psychology intern documented in her notes that Maria reported she had started to date again. She noted that Rosalinda’s symptoms had gotten worse (for example, she is upset when left with the family babysitter).

Please address the following questions:

 

Can Rosalinda’s Dad have access to the child’s record?

 

What about the reference to Maria starting to date – should this be documented in the record? Should Rosalinda’s father have access to this information?

 

Explain your reasoning, referring to the appropriate rules and citing ethical guidelines (these may include the practice act, rules of board, etc.).

Confidentiality

Purpose

A hallmark of psychological practice is the privacy and confidentiality that psychologists must observe to protect the well-being of their clients. This session will focus on the intricacies of maintaining confidentiality and when it is required by law to be disclosed.

Objectives

1. Define confidentiality and its limitations and exceptions.
2. Examine situations where there may be a duty to warn or protect third parties.

3. Introduction to HIPAA

In most situations the law recognizes the psychologist(therapist)/patient relationship. There are exceptions. All states now have rules for reporting child abuse, most have rules for reporting elder abuse. The “Duty to Warn” (from Tarasoff) is often written into the practice act or rules of state psychology licensing boards but not in all jurisdictions. Indeed, there is no duty to warn in some jurisdictions. This is complicated, because if you follow the law a person could be harmed due to your lack of action. While there is no affirmative (must do) requirement to intervene in threat to others, you can assume that you will be found negligent if your patient is actively suicidal and you do nothing.
Privilege relates to the legal protection from being forced to break the expectation of confidentiality. Parents are the holder of privilege for minor children but many jurisdictions allow exceptions for some types of confidences.
Remember, like the attorney or priest, the confidentiality between psychologist and client is “sacred.” It is protected by law and tradition. However, unfortunately, some state laws increasingly infringe on that indispensable element. Thus, psychologists face increasing conflict among their professional ethics, their concern for clients, and their legal obligations.