Professional Practice: Assessment

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Professional Practice Assessment

• Lecture 16, November 2, 1998
• Wrap-up Counseling as a Recursive Dynamic

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Announcements

• Specialty areas
• Administration and Supervision (Maki)
• Aging and Rehabilitation (Wadsworth)
• Brain Injury Rehabilitation (Tarvydas)
• Community-based Rehabilitation (Townsend)
• Law and Disability (Blanck)
• Psychiatric Rehabilitation (ORourke)
• School-to-work Transition/SE (Harper?)
• Spanish-English Emphasis (Peterson)
• Substance Abuse Counseling (Skinstead)

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Review Completion Counseling as a Recursive
Dynamic

• Process and relationship
• Meaning
• Empowerment

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Theoretical shift from vocational tradition to

• Person-Centered Therapy
• Psychosocial counseling
• Systemic- and ecologic-oriented counseling

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Broadening of Rehabilitation Counselings Scope
of Practice

• Community Mental Health
• Substance Abuse and Chemical
• Dependency
• Psychiatric Rehabilitation
• Proprietary Rehabilitation
• other clinical settings

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We reviewed...

• Microcounseling Skills
• Critical factors in the counseling process
• Assist the client in deriving maximum meaning
  from his or her situation (awareness)
• Empower the client toward outcomes
• Strategically address time limitations

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Learning to Write as a Metaphor for Learning to
Counsel

• Recursive writing
• The whole continually refers back to parts of
  itself
• Effective writing
• Must be iterative or self-referent
• Generative
• Invoke parallel structures

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Effective Counseling Must be Recursive

• Mastering the basic use of helping skills
• Everything that happens in counseling must loop
  back to the clients context
• This iterative process leads to greater insight
  through self-reflection (awareness)

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The Effective Counselor...

• helps the client to make connections that are
  meaningful
• assures that the relationship is interactive
• not dominated by the counselor
• engages in self-reflection as part of the
  parallel process
• This self reflection will be important for future
  counselors who you supervise

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The Recursive Dynamic

• Using selected counseling strategies, counselor
  helps client to construct new self-knowledge
• Self knowledge RECURS to self-reflection
• Self-reflection generates increased
  self-awareness
• This self discovery predicates client action

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(resuming...) Dialectical Thinking

• An event (thesis) generates its opposite
  (antithesis), leading to a reconciliation of
  opposites (synthesis)
• This opposes either-or, all-or-nothing logic
• Counseling is often a nonlinear process
• This requires dialectical thinking
• Art versus Science
• We need theory and research, but we also need
  individual sensitivity

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Dont forget the basicsBricks held together by
mortar (science)

• attending
• empathy
• probing
• respect
• understanding
• warmth
• genuineness
• self-responsibility

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Two Relationships

• 1 The recursive relationship of counseling
• Continue to return to the clients context
• 2 The recursive relationship between counselor
  and client
• Client and counselor are self reflective,
  counselor is aware of this parallel process

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Together.

• these relationships create opportunity for
  meaning making and empowerment
• A collaborative movement from presenting problem
  to successful change

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Counseling is defined in terms of Process
Relationship

• Process
• Research supports the efficacy of counseling and
  psychotherapy by focusing on commonalties across
  approaches
• Type of intervention is guided by client need and
  client context
• Primary dimension is self knowledge (awareness)
• Awareness of the clients quest
• Awareness of your helping strategy

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Process

• Action
• The action/change dimension of counseling must be
  considered carefully within a multicultural
  context
• Action can be behavioral or cognitive
• Change
• Cognitive reframing, emotional growth, increased
  awareness,
• Change implies recursion
• Meaning
• Existential Meaning making is recursive
  (referring back to the past to derive meaning)

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Relationship

• Working alliance
• Significant factor in research
• Collaboration
• with a power differential to which it is
  ethically important to attend
• Holistic approach
• People are cognitive, emotional, behavioral,
  spiritual, social, vocational, and existential

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Relationship cont.

• Context
• Important to avoid assumptions, ask good
  questions, minimize influence during information
  gathering phase of the relationship
• Empowerment
• Helping client discover his or her ability to
  change
• Using a participatory rather than directive style
• Realize the two-way influence of a helping
  relationship (you can learn from the client)
• Democratize the counseling process

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Counseling is comprised of fluid, interactive,
and recursive stages

• Constructing an effective working alliance
• Generally occurs within the first few sessions
• Establish and mediate goals, initiate client
  change
• More elastic of the stages
• Resolution to client concerns
• Takes up the last few sessions

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Iveys Conceptualization (for comparison)

• Rapport/Structuring
• Problem defintion/identification of assets
• Defining outcomes
• Exploring alternatives, confronting incongruity
• Generalization
• You will encounter other models. Which do you
  prefer?

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Categorical Ordering of Major Counseling
Dynamics...

• ...that Occur Throughout Levers Recursive Stages
• Stage 1
• professional disclosure
• client role induction
• establishing trust
• data collection
• identifying problems-identifying purpose
• conceptualizing the case
• initiating the working alliance

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cont.

• Stage 2
• developing the working alliance
• refining case conceptualization/diagnosing
• setting goals-marking purpose
• planning interventions
• meaning-making
• checking progress

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cont.

• Stage 3
• facilitating client-acquisition of therapeutic
  gain
• determining an end point
• planning termination
• potential referrals for additional or ongoing
  services
• terminiation
• Sequential progression through stages is always
  recursive

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Multicultural Counseling

• the fourth force, using sensitivity toward
• Race
• Ethnicity
• Gender
• Disability
• Spirituality
• Sexual orientation
• awareness of world views, values, opinions, and
  concepts

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The Ecological Perspective

• Larger culture
• Subculture affiliations
• Systemic relationships

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Importance of Vocational Counseling Skills for
the Rehabilitation Counselor

• Roessler Rubin Ch 2
• What perspective do the authors take in the
  ARCA/NRCA debate over the centrality of
  counseling in rehabilitation counseling?

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Murphy, 1988

• Focused on the vocational emphasis of
  rehabilitation counseling
• Psychosocial outcomes reportedly sought from
  other professionals
• Most salient counseling issue is stress secondary
  to unemployment or underemployment, supporting
  the vocational focus
• Summary Quality of life strongly influenced by
  vocational situation

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Rehabilitation Counselors Vocational Counseling

• Rehabilitation counselors need to be skilled in
  vocational counseling
• Create experiences that allow a person to
  explore self within the context of work
• Knowledge of self, educational options,
  vocational possibilities enhance outcomes
• Persons with disabilities job satisfaction was
  strongly related to appropriate interest match
  with specific vocational area

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Match Between Person - Environment

• Chartrand (1991) , Trait-factor approach
• 1) Peoples decisions are influenced by cognitive
  and affective factors
• 2) People and work environment differ on
  measurable and meaningful dimensions.
• 3) Matching a persons traits and a work
  environments factors enhances success
• 4) Congruence between person and environment is
  not static people and environments have the
  capacity to change.
• 5) People seek and create environments that allow
  expression of preferred characteristics
• How does disability impact 5??

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Environmental Factors in Vocational Choice Process

• Location, structure, and amount of interpersonal
  support.
• Example A client has been working in
  supported-employment setting, where all of his or
  her friends reside, and was walking distance from
  his home. Now, he or she has gotten a new job
  with a major company in the community but none of
  his personal acquaintances are there, and it is
  located ten miles by bus from his home.

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Individual perception of significance of his or
her disability

• 1) Vocational plans, interests and work values
  held prior to disability
• 2) Critical variables are returning to and
  maintaining employment, motivation to work,
  realistic self-assessment of capacities and
  limitations, and optimism.
• 3) Interruption in career patterns from
  hospitalization, medical treatment and other
  treatment due to disability.
• 4) The differences between invisible disability
  and visible disabilities.

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cont.

• 5) Cultural expectations and parental and teacher
  expectations
• 6) Economic status affects vocational plans.
• 7) Persons with physical disabilities often more
  advanced than persons with developmental
  disabilities.
• 8) Prior work experiences affects the chosen
  occupation.
• 9) People with congenital disabilities choose
  occupations consistent with parental aspirations.

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MTWA

• Lets try to define this theory as a class, on
  the board

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MTWA

• Individuals seek to establish and maintain
  correspondence with their environment
• Satisfaction, satisfactoriness, tenure
• Extrinsic rewards (), intrinsic rewards
  (personal satisfaction), social rewards (contact
  with others in the work place)
• Pay-offs Achievement, comfort, status,
  altruism, safety, autonomy

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The Crux Model (RR, 1980)

• Dynamics of vocational counseling process
• Two major phases
• Evaluation
• Planning
• Describes the relationship between the two
• The model directs the counselors efforts in
  collecting significant social-vocational history
  information and relating it to work demands.
• See (Table 2.1, p.33-35, RR)

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Crux Model cont.

• Evaluation (Table 2.1)
• Physical factors
• Psychosocial factors
• Educational-Vocational Factors
• Economic Factors

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Crux cont.

• Note implications of evaluation data for
  vocational options
• Prepare suggestions for discussion
• Help the client through the process of increasing
  awareness relative to the findings, agree on a
  goal
• As weve mentioned, the process in collaborative,
  your role consultative

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Crux cont.

• If the client is having difficulty adjusting to
  his or her disability status, counseling
  interventions facilitate adjustment and help to
  create realistic expectations
• If further assessment is necessary, you are
  ethically responsible to understand the process
  yourself, and be able to clearly communicate the
  issues to your client

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Assessment

• Berven, Maki Riggar Chapter 10
• Assessment is basic to virtually ALL functions
  within the scope of practice of rehabilitation
  counselors
• Analysis and definition of the problem
• Establishing goals, identifying barriers
• Strategies and comprehensive service plans

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Levels of Assessment

• Global level
• Basis of service plans
• Specific level
• Strategies in response to encountered barriers
• More specific level
• Moment-by-moment interactions, e.g., determining
  an appropriate verbal response in a given context
  that will produce an intended response or outcome

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Assessment Practice Continuum

• Medical model, counselor as expert
• Collaborative effort between counselor and
  consumer/client
• Counselor as consultant, consumer-driven
• Assessment.
• often associate with the rehabilitation
  counselor having control of decision making and
  service delivery

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Cronbachs Conceptualization (1990)

• Maximum performance
• Used to predict best performance
• ability, aptitude, achievement
• Typical performance
• How an individual might typically behave in
  various situations
• interests, values, personality characteristics

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Reliability

• Degree to which scores are free from errors of
  measurement
• Consistency of socres obtained by the same
  persons when reexamined on different occasionsor
  under other variable conditions

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Validity

• What the test measures, and how well it does so
• Tells us what can be inferred from scores

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Scale example

• Get on and off a scale a number of times and
  record the results
• The consistency of the weight measured would
  reflect evidence for reliability
• The accuracy of the weight reading on the scale
  in comparison with an absolute standard would
  provide evidence for validity

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Standardization

• Established normative sample
• Carefully specified procedure for administration
  and scoring of each member of the normative
  sample
• Standardized administration of the test to others
  can be scored and results compared to the
  normative sample
• Issues for people with disabilities?

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Assessment Methods

• Interviews
• Standardized Tests and Inventories
• Simulations of Work and Living Tasks
• Simulated and Real Environments
• Functional Assessment
• Systemic approach to describing skill, current
  behavior, or both
• Integration of interviews, observation,
  self-report, examinations

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Interpretation and Synthesis of Assessment
Information

• Interpretation Degrees of Inference
• Lowest Samples of behavior in their own right
• Next higher level Bits of information are
  interrelated in search of consistencies and
  generalizations
• Next higher level A hypothetical construct
  (e.g. depression) may be used to describe the
  essence of the consistencies or generalizations
  identified

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Note

• Interpretation can often be far removed from the
  original data source
• Keep this in mind when consuming and interpreting
  data

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Organization of Information

• Assets
• Limitations
• Preferences
• Information that addresses the individual AND the
  environment

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Synthesis of Information

• Comprehensive working model of the individual
• Begins with INDUCTIVE reasoning
• inferences are drawn about individual bits of
  information and apparent consistencies between
  them
• ...then DEDUCTIVE reasoning is used...
• formulate and test hypotheses regarding the
  usefulness of the working model (accounting for
  already available info as well as predictions

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Working Model revisions

• To the extent that the model does not account for
  or predict relevant information, the model is
  revised based upon new data gathered

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Danger! Bias in Interpretation and Synthesis

• Nezu Nezu, 1993
• Availability heuristic
• Readily recalled past experience exerts undue
  influence, fail to consider other explanations
• Representativeness heuristic
• Belief about individuals who share one feature
  will likely share another (stereotypes)
• Anchoring heuristic
• Initial impressions that are resistant to change

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Final Phase of Assessment Clinical and Service
Decisions

• Common to RC practice (detail in chapter)
• Selection for service
• Establishment of vocational objectives
• Identification of needed interventions
• Formulation of case service plan
• Disability determination
• Make use of the working model of the individual
  to make predictions corresponding to the above
  areas

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Future Perspectives

• Number of assessment tools available is
  ever-increasing
• Tests in Print IV (1994) indicated over 3,000
  commercially available
• Work sample/related systems 18 (Brown et al.,
  1994)
• Job Search software systems 12 (Berven, 1997)
• These numbers will likely increase dramatically
  in the years ahead

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Computerized Assessment

• Burkhead and Sampson (1985) reviewed applications
  in rehab counseling
• Recent advances include the use of Adaptive
  Testing for tests like the GRE, Marriage and
  Family Therapy Board Exam, and even State Drivers
  License Bureaus
• Adaptive testing decreases the number of items
  administered, and bases each subsequently
  administered item upon the response to the former

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