Chapter 22: Assessment in routine clinical and counselling settings

AUTHORS:  C. Young, D. Edwards

ABSTRACT: This chapter examines the principles of assessment applied to clinical and counselling settings in which clients seek help for such problems as depression, anxiety, eating disorders, or other problems related to trauma, relationship conflict, or difficulties with self control or substance use. The aim of assessment is to obtain an understanding of the client’s difficulties and the context in which they arise sufficient to form the basis of a management or treatment plan. In adults, the main method of assessment is an interview structured to elicit information about the presenting problem, its time course and context, factors that might have precipitated it, case history relevant to understanding the client’s vulnerabilities.  In addition, information is gathered on which to base a diagnosis and an evaluation of risk that the client may harm self or others. Other methods of assessment, particularly with children, include interviews with family members or other significant individuals (for example school teachers, employers) as well as observation (for example of classroom behaviour) or self-monitoring. For children observation of play or interaction between caretaker and child in a playroom may be valuable.  This chapter examines the application of clinical assessment in South African conditions based on case examples and published case studies and discusses the problems and challenges that practitioners face due to time constraints, shortage of resources or cultural and contextual factors.

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Chapter 23: Assessment and Monitoring of Symptoms in the Treatment of Psychological Problems

AUTHORS: D. Edwards, C. Young

ABSTRACT: This chapter considers the clinical application of brief symptom measures in South African contexts. Although typically developed in the USA and UK, these measures can assist South African clinicians to assess the severity of their clients’ presentations, to track the progress of psychological therapy from one session to the next and to evaluate therapy outcomes. There is evidence for their value not only for research but also for practice, as such systematic tracking of symptoms improves clinical outcome. While many competing measures have been developed over the years, a few dominate in the literature and even fewer have been used and at least partially validated in South Africa. This chapter summarizes recent local validation studies on the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), and of the Xhosa translations of the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI) and the Beck Hopelessness Scale (BHS).  Other disorder-specific measures that have been used in local contexts include the Alcohol Use Disorders Identification Test (AUDIT) and a number of trauma scales such as the Posttraumatic Diagnostic Scale (PDS), the Impact of Events Scale (IES), the Posttraumatic Cognitions Inventory, and the Traumatic Grief Inventory (TGI). The utility of these scales in everyday settings, and their interpretation in conjunction with other assessment data are examined by reference to clinical examples, including published case studies.  Problems encountered in the translation of scales as well as their use in local multicultural and multilingual contexts are discussed.

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