Diagnostics SPHS 5780 (Lecture 5)

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DiagnosticsSPHS 5780(Lecture 5)
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Information gathering

Look for these process components on your syllabus
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Information Gathering

• Remember there will be complications and
  challenges
• Remember that a diagnostician has to be creative,
  flexible, innovative
• E.g., language barrier
• E.g., preconceived ideas
• E.g., poor ability to articulate the problem
• E.g., hesitancy to disclose information
• E.g., too much information (which is most
  important?)
• E.g. time management

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Information gatheringCase history taking
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Transition (Thought question)Sources of
pre-session inferences about a clients case
history

• Examination request implies problem
• Setting, as associated with client types
• Age, as associated with disorder type
• Referral, depending on level of detail and
  accuracy
• Beware mislabeling by lay persons and other
  professionals
• Records of prior diagnostics and treatment
• Written case history questionnaire

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Information gatheringCase history taking

• Written case history
• Information-gathering interview

Combine the two for a complete case history
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Case history taking Written Case history
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Written Case history

• From client
• In written form (case history questionnaire)
• From other sources
• Review of written documentation (cf. use of
  note-gathering card).
• Release of information must be authorized (HIPPA,
  Health Insurance Portability and Accountability
  Act)

Can you articulate some advantages and
disadvantages of this means of information
gathering?
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Written Case history

• Advantages
• Time efficient, and allows time for thinking
• Comprehensive
• Can be tailored to specific disorder /patient
  type

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Written Case history

• Disadvantages
• Although time efficient..
• Advance preparation does not allow for
  clarification
• Although comprehensive
• May be difficult for some to understand
• May be overwhelming to client (with no clinician
  feedback)
• Taxing to the memory of the client/family
• Although tailored to clinical background of
  client
• May be difficult to tailor to CLD populations
• May seem odd or alien to some CLD populations

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Written Case history

• Thought question
• Think of a written case history that youve
  filled out.
• What did you like about it?
• What did you not like about it?

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Written Case history

• Characteristics of a good written case history
  form
• Appropriate length
• Easy to read/understand
• No jargon
• e.g., not auditory comprehension but rather
  ______________________
• Clear questions
• Asks for both facts (objective) and opinions
  (subjective)
• Provides opportunities for client-directed input
  (open-ended questions)
• E.g., What else would you like us to know.

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Written Case history

• Which might be included in written case
  questionnaire?
• How might they be worded?
• What might be added?

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Written Case history

• Whether information is from client or from other
  sources, take all information at face value and
  with awareness that it may contain errors

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Written case history

• If case history is prepared in advance of
  appointment, allow time for (even brief) review
  of case history with client the day of the
  diagnostic. (SR, p. 5)
• Why?

Transition to the case history interview
(information-gathering interview)
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Case history taking information-gathering
interview
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Information-gathering interview Preliminaries

• Information-gathering interview is only one type
  of interview
• Clinical interview types
• Information-getting
• Information-giving
• Counseling

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Information-gathering interview Preliminaries
Interviews in general fill more than one purpose
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Information-gathering interview Preliminaries

• Interview is different from conversation
• Dyadic communication with a predetermined purpose
• Someone has specific knowledge or expertise and
  someone benefits from that knowledge and
  expertise
• Flexible exchange of information

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information-gathering interview
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Information-gathering interview

• From client
• Verbally
• From other sources
• (Why not verbally, usually?)

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Information-gathering interview

• Stages (SR, Ch. 5)
• Pre-session orientation
• Information-gathering interview proper
• Opening
• Body
• Closing

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information-gathering interview Pre-session
orientation
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Information-gathering interview

• Pre-session orientation and preparation minimize
  uncertainty and anxiety

• Pre-session orientation
• People (administrator, receptionist, clinician)
• Modalities (written/printed, phone)
• Content (orienting information, case history
  form)
• Pre-session preparation of interview setting
• Privacy
• Appearance of setting
• Timing (adequate time and appearance of adequate
  time)
• Seating arrangements and distance

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Information-gathering interview

• Pre-session orientation and preparation minimize
  uncertainty and anxiety

• Pre-session gathering of information about the
  clients culture
• Familiarity with healthcare or educational system
• Beliefs about procedures you may conduct
• Beliefs about health, illness, and disability
• Knowledge of health conditions prevalent in
  population
• Your status and that of others in dynamic
• How conversations are started, conducted, and
  ended
• Use of non-verbal communication

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information-gathering interview (other sources
of anxiety and ways to diffuse them)
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Information-gathering interview

• Sources of clinician anxiety
• Lack of experience
• Lack of knowledge about a specific disorder
• Fear of disagreement and/or emotional reactions
  from client/family
• Sources of patient/family anxiety
• Uncertainty about the evaluation experience and
  the clinician
• Fear of hearing bad news
• Previous negative experiences with
  clinicians/therapists

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Information-gathering interview

• Ways to diffuse anxiety

Be organized Use a warm, friend, competent and
professional tone of voice Listen attentively to
client/family - Do not become preoccupied with
writing or thinking about the next
question Convey empathy, respect, and
understanding of the client/familys
situation Pay attention to non-verbal
communication Take advantage of opportunities to
provide positive reinforcement.
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information-gathering interview Opening
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Opening provides information and builds rapport

• Roles and titles (forms of address cards name
  tags)
• Purpose
• Days plan and its rationale
• Confidentiality

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information-gathering interview body
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Body acknowledges that client is boss and that
you are working as a team
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• Issues that are addressed regardless of disorder
• Perspective and background of client
• Time course
• Variability
• Past treatment
• Barriers and facilitators
• Contexts of communication
• Content General, as well as specific to disorder

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• Asking effective questions
• Learning to ask good questions is essential to
  good interviewing
• Characteristics of good questions
• Clear and concise
• One at a time
• Give adequate time to answer
• Allow interviewees to tell their story
• Allow fact and opinion, but understand the
  difference
• Types of questions
• Open questions encourages concerns/opinions/gener
  al info
• Closed questions encourages a specific response

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• Asking effective questions (cont.)
• Funnel approach vs. inverted-funnel approach
• Start with open questions vs. start with closed
  questions
• Which one is more common in interviews?
• When might the other one be effectively used?
• Primary vs. secondary neutral vs. leading
  reporter questions
• Use of everyday vs. technical language
• Guided interview vs. allowing for
  sponteneity/flexibility

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information-gathering interview closing
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Closing is composed of recap, acknowledgement,
and road map

• Summary
• Clarification
• Thanks
• Whats next