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Expanding Your Assessment Toolbox

Expanding Your Assessment Toolbox. Bradley Jackson, Ph.D. The Children’s Hospital Aurora, CO Robert Stadolnik, Ed.D. FirePsych, Inc/Brandon School Medway, MA May 14, 2009 3 rd Annual Northeast Juvenile Firesetting Intervention Conference Worcester, MA. Evidenced Based Assessments.

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Expanding Your Assessment Toolbox

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  1. Expanding Your Assessment Toolbox Bradley Jackson, Ph.D. The Children’s Hospital Aurora, CO Robert Stadolnik, Ed.D. FirePsych, Inc/Brandon School Medway, MA May 14, 2009 3rd Annual Northeast Juvenile Firesetting Intervention Conference Worcester, MA B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  2. Evidenced Based Assessments • Avoid clinical judgment alone which is a poor and inconsistent method. (Mills, 2005) • Encourage frameworks that promote systemization and consistency, yet are flexible enough to adapt to individual needs. (Doyle and Dolan, 2002) • Allow for integration of science and practice. (Borum, 2006) • Collect, structure, and usually quantify the impressions of child, caregivers, and professionals. (Hunt and Johnson, 1990) B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  3. Evidence Based Assessment of Conduct ProblemsMcMahon and Frick (2005) EB Assessment requires use of a multiplemethods strategy Interviews (Parent, Child, Family) Behavioral Measures Behavioral Observations Evaluate Co-Morbid Adjustment Problems (ADHD, Anxiety, Depression, Social Rejection, Substance Abuse, Learning Disability) Issues Relevant to Assessment 1) Severe CP’s cover a broad range of antisocial and aggressive behaviors. ODD vs. CD, CD: overt-covert, destructive-nondestructive 2) Youth’s with CP’s often have a number of adjustment problems. 3) There are a large number of risk factors that can have additive or interactive effects. 4) Impact of risk factors can differ across subgroups of youths with CP. B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  4. Evidenced Based Assessments and Firesetting • Previous authors have reported on importance of a comprehensive diagnostic approach. (Kolko and Kazdin, 1989; Fineman, 1995; Sakheim and Osborn, 1994; Stadolnik, 2000; Wilcox, 2006) • Assessment is the combination of both scientific process and artistic endeavor. (Stadolnik, 2000) • Evaluator must embrace a diverse array of data with increased need for collateral contacts. (Wilcox, 2006) • Evaluator must collect and analyze data from multiple domains.(Fineman, 1995; Humphreys and Kopet, 1996; Kolko, 1999; Stadolnik, 2000; Wilcox, 2006) B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  5. Constructing Your Assessment Protocol Factors: • Population Served • Funding/Insurance, etc. • Service Delivery Model • Prior Training and Experience • Supervision and Training Opportunities B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  6. Statistics 101 B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  7. Statistics are our friend • The normal curve • Standard deviations • Statistical confidence • Establishing cutoff scores • False positives and false negatives B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  8. Examples • Not distributed evenly • A few at the extremes pull the average/mean so that it becomes a confusing summary score • Standardizing any distribution helps us to compare with more consistency and confidence B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  9. Standardized scores • Mathematically transforming a raw score (or any score) into a standard score allows us to use what we know about the normal curve • Here are some more well-known standard scores IQ scores (mean = 100, std dev = 15) GRE/SAT score (mean = 500, std dev = 100) T scores (mean = 50, std dev = 10) • For all of these transformations, equal differences between people will result in equal differences between the scores, so now we can actually compare test scores and know what the differences mean. B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  10. Percentile • The percentile of a score tells you what proportion of the population received that score or lower. • The mean of percentiles is 50% and the range is 0% to 100%. • The scores do not have to follow any particular distribution so be sure to use a program or chart that standardizes the percentiles. B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  11. T scores help us determine how extreme a test score actually is B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  12. Reporting test results • Raw score • T score • Percentile • Total score • Scale score • Special score • Critical item B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  13. Firesetting Assessment DomainsStadolnik, R. (2000) • Behavioral Functioning • Social/Emotional Functioning • Parent/Family Functioning • School/Cognitive Functioning • Firesetting Behavior History • Fire Scene Evidence B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  14. Assessment Practice Methods: Record review Clinical and Collateral Interviews Observation reports Standardized measures Questions to answer: Are behaviors acute or chronic? What is the rate of progression? Consensus among reporters? Is impulsivity present? Criminal charges or police contact? Direct aggression to people or animals? Periods of improved behavior? Current behavior? Behavioral Measures Achenbach CBCL, TRF, and YSR Behavioral Assessment System for Children (BASC) Connor’s Rating Forms Aggression Measures Aggression Questionnaire Novaco Anger Scale and Provocation Inventory Overt Aggression Scale Interview for Anti Social Behavior Others Behavioral Functioning B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  15. Child Behavior Checklist (Achenbach) • Self Report Format • Parent, Teacher, and Youth Versions • Ages 6 - 18 • Takes 15 - 20 minutes to complete • Computerized scoring and reports B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  16. CBCL/Achenbach Subscales • Competence Scales (20 items, 2 open- ended questions) • Activities • Social relations • School performance • Total (e.g., list your child’s sports and rate how often and how well they do each one compared to other same-age children) B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  17. Child Behavior Checklist • Behavior Problems Scales (118 items, plus 2 open-ended items) • Parents rate their child for how true each item is now or within the past 6 months using the following scale: • 0 = not true (as far as you know) • 1 = somewhat or sometimes true • 2 = very true or often true • Example items - argues a lot; impulsive or acts without thinking; sets fires; unusually loud; unhappy, sad, or depressed • Internalizing, Externalizing, and Total Problem Scales B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  18. Cross Informant Syndromes: Anxious/Depressed Withdrawn/Depressed Somatic Complaints Social Problems Thought Problems Attention Problems Rule-Breaking Behavior Aggressive Behavior DSM-oriented scales: Affective Problems Anxiety Problems Somatic Problems Attention Deficit/ Hyperactivity Problems Oppositional Defiant Problems Conduct Problems Child Behavior Checklist B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  19. Novaco Anger Scale and Provocation InventoryNovaco, R. (2003) • Two-part, self report measure with 85 total items • Ages 9 to 84 • For use in research, individual assessment, and outcome evaluation • Designed to assess anger as a problem of psychological functioning and physical health • Hand Scored B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  20. Novaco Anger Scale and Provocation Inventory(NAS-PI) NAS-PI Scores Cognitive (COG)-thoughts of justification, suspicion and hostility. Arousal (ARO)-elevated physiological response to anger. Behavior (BEH)-confrontational and antagonistic behaviors or verbalizations. Anger Regulation (REG)-suggests effective regulation skills, potential strength. NAS Total-overall levels of angry behaviors and thoughts. Provocation Inventory PI Total-an index score of anger intensity across a range of provocations: disrespect, unfairness, frustation, annoyances. B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  21. The Aggressive Adolescent Cognitive Characteristics Narrow bands of imagination (concrete-operational), habitually ruminate on violent self perceptions, and appraise all situations in a hostile manner. Affective Characteristics Narrow band of emotional expression, frequently seen as unhappy or unwell (dysphoric), dichotomous expression of anger from overcontrolled to undercontrolled. Behavioral Coping Skills Lack basic social skills and have low assertiveness skills. Poor negotiators and unable to delay gratification. Need to be taught how to avoid conflicts. Davis, D. (2000). The Aggressive Adolescent: Clinical and Forensic Issues. New York. Haworth Press. B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  22. Affective vs. Predatory Modes of Violence Affective: • Intense ans arousal • Extreme experience of emotions • Reactive and immediate • Internal or external threat • Goal is threat reduction • Rapid displacement of target • Time limited behavior • Preceded by public posturing • Primarily emotional • Heightened and diffuse awareness Predatory: • Minimal or no ans • No conscious emotions • Planned and purposeful • No or minimal threat • Many goals • No target displacement • No time limit • Preceded by private ritual • Primarily cognitive • Focused awareness B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  23. Assessment Practice Methods: Clinical Interviews Parent Interviews Review of Records Collateral Contacts Psychiatry Consultation Observations Standardized Measures Questions to Answer: Acute or Chronic? Level of severity/impairment? Past interventions? Medication needs? Affect vs. thought? DSM IV Classification? Measures Jesness Inventory Millon Adolescent Clinical Inventory (MACI) Millon Pre-Adolescent Clinical Inventory (M-PACI) Rorschach Inkblot Test Children’s Depression Inventory Trauma Symptom Checklist for Children Personality Inventory for Youth Clinical Assessment of Interpersonal Relationships (CAIR) Thematic Apperception Test (Test) Social Skills Relationship Inventory (SSRI) Trauma and Attachment Belief Scale MMPI-A Projective Drawings Others Social/Emotional Functioning B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  24. Jesness Inventory- Revised (JI-R) • Youth self-report • 160 true/false items • Ages 8 yrs and older • Computerized scoring, hand-scoring templates, online administration • 30 – 45 minutes DSM-IV Scales • Conduct Disorder • Oppositional Defiant Disorder B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  25. Manifest Aggression Withdrawal-Depression Social Anxiety Repression Denial Asocial Index Jesness Inventory-Revised Personality Scales • Social Maladjustment • Value Orientation • Immaturity • Autism • Alienation B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  26. Pragmatist Autonomy-Oriented Introspective Inhibited Adaptive Jesness Subtype Profiles • Undersocialized, Active • Undersocialized, Passive • Conformist • Group-Oriented • Pragmatist B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  27. Trauma Symptom Checklist (TSCC) Youth self-report measure of post-traumatic distress 54 items Ages 8 – 16 Hand Scored Profile Form B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  28. Validity Scales Underresponse Hyperresponse Clinical Scales Anxiety Depression Anger Posttraumatic Stress Dissociation (3) Sexual Concerns (3) Critical Items TSCC B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  29. Millon Adolescent Clinical Inventory (MACI) Millon, T. (2006) MACI Features • 160 items, True/False, self report measure • Ages 13-19 • Summarized in computer generated narrative reports • Examines three distinct categories: Personality Patterns, Expressed Concerns, and Clinical Syndromes B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  30. Millon Adolescent Clinical Inventory (MACI) Base Rate (BR) Interpretations • MACI raw scores are transformed into BR scores • BR scores are a measure of the rate at which a characteristic is present in the norm population. • For each MACI scale BR scores are anchored at 75 and 85. 85= represents adolescents for whom this trait is most prominent 75= represents adolescents for whom the trait is prominent or present B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  31. Millon Adolescent Clinical Inventory (MACI) Personality Patterns -traits and features combine to form a pattern - Style derived from combining three polarities: 1) pain-pleasure, 2) active-passive; and 3) self-other Scale:Name: 1 Introversive 2a Inhibited 2b Doleful 3 Submissive • Dramatizing • Egoistic 6a Unruly 6b Forceful • Conforming 8a Oppositional 8b Self Deprecating • Borderline Tendency B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  32. Millon Adolescent Clinical Inventory (MACI) Expressed Concerns -focus is on feelings and attitudes about issues that concern the adolescent -intensity of those feelings is reflected is score elevation - it’s perceptions, not objectively observable or behavioral criteria Scale: Name: A Identity Diffusion B Self Devaluation C Body Disapproval D Sexual Discomfort E Peer Insecurity F Social Insensitivity G Family Discord H Childhood Abuse B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  33. Millon Adolescent Clinical Inventory (MACI) Clinical Syndromes -assesses disorders that manifest themselves in specific form -best seen as an extension or distortion of the adolescent’s personality -are transient, they wax and wane depending on stressors Scale: Name: AA Eating Dysfunctions BB Substance Abuse Proneness CC Delinquent Predisposition DD Impulsive Propensity EE Anxious Feelings FF Depressive Affect GG Suicidal Tendency B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  34. Assessment Practice: Methods: Direct interview Data from collateral reporters Home visit Milieu observation reports Standardized measure Questions to answer: Overall emotional climate? Relationship/attachment quality? Discipline practices? Family resources? Parent mental health? Marital strength? Measures: Parenting Stress Index Family Conflict Scale Parent-Child Relationship Inventory Family Assessment Measure III Alabama Parent Questionnaire Others Parent /Family Functioning B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  35. Family Assessment Measure-Version 3Skinner, B., Steinhauer, P., and Santa-Barbara, J. (1995) FAM III Features • Self report measure, takes 30-40 minutes to complete • Ages 10 and older • Provides a quantitative description of family strengths and weaknesses • Can be completed by all members of the family • 3 Scales: General Scale, Dyadic Relationship Scale, Self-Rating Scale B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  36. Family Assessment Measure-Version 3FAM III FAM III Subscales Task Accomplishment- basic tasks met, flexible, alternative solutions are explored Role Performance-family understands expectations of roles, and agrees, adapt to new roles Communication- direct, clear, open, sufficient Affective Expression-full range of affect when appropriate and with correct intensity Involvement- empathic involvement, concern for others, nurturing Control- patterns of influence, adaptable, predictable yet flexible, constructive Values and Norms-consistent with family subgroup, explicit and implicit rules are consistent B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  37. Family Assessment Measure-Version 3FAM III Interpretive Guidelines: • Elevated scores (T>60) must be interpreted for alternative explanations (Ex: Involvement) • The more family members who indicate and elevated score in a particular area, the more likely it is problematic. • Total number of elevated scores correlates to overall family pathology. • Greater discrepancies among spouse profiles suggest marital discord • Differentscores elevated for different members of the family suggest perception differences. B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  38. Assessment Practice Methods: Fire History Interview-Child Parent Interview Structured Interview Tools Record Review Collateral Reports Questions to Answer: When ? How? Where? Who? What? Why? Structured Interview Tools: Children’s Firesetting Interview Firesetting Risk Interview Graphing Technique Oregon Screening Tool FIRE Protocol Fire Risk Interviews (Child, Parent, Family)-FEMA Others Firesetting Behavior History B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  39. Use of drawings during the assessment interview can help to: Immerse the child in the memory Engage the child in multiple modalities of sharing (verbal, visual) Types of drawings Self Tree Family doing something Safe fire Unsafe fire Drawings B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  40. Individual fire graphs • From a list of all firesets/fireplay, the child selects a significant fire incident and details the sequence of events before, during and after the fire • Cartoon or panel technique for fire drawings • Written graph encourages child/teen to link thoughts and feelings to the sequence of events B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  41. Written Fire Graph • Describe the situation & the sequence of events • Usually aware of events occurring during the fireset and after • Focus on the events before fireset • Slow down the description • Ask clarifying questions • Focus on possible precipitating triggers earlier in the day/week/month • Add corresponding thoughts and feelings B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

  42. Bibliography Achenbach, T. (2001) Manual for the Achenbach System for Empirical Behavior Analysis. University of Vermont. Burlington, VT. Borum, R. (2006). Assessing risk for violence among juvenile offenders. In Forensic Mental Health Assessment of Children and Adolescents (Sparta, S and Koocher, G. Eds.). Oxford University Press. London. (pgs190-203).  Doyle, M. and Dolan, M.(2002). Violence risk assessment: combining actuarial and clinical information to structure clinical judgments for the formulation and management of risk. Journal of Psychiatric and Mental Health Nursing. 9. 649-657.  Fineman, K. (1995). A model for the qualitative analysis of child and adult fire deviant behavior. American Journal of Forensic Psychology. 13(1). 31-60.  Humphreys, J. and Kopet, T. (1996). Manual for the Juvenile Firesetter Needs Assessmnet Protocol. Oregon State Fire Marshal. Portland, OR.  Hunt, F. and Johnson, C. (1990). Early intervention for severe behavior problems: the use of judgment based assessment procedures. Topics in Early Childhood Special Education. 10(3). 111-122. Jesness, C. (2003). Jesness Inventory-Revised Manual. Multi-Health Systems. North Tonowanda, NY. Kolko, D. (1999). Firesetting in children and youth. In V Van Hasselt & M. Hersen (Eds.), Handbook of Psychological Approaches with Violent Offenders: Contemporary Strategies and Issues. 95-115. Kluwar Academic/Plenum Publishers. New York. Kolko, D. and Kazdin, A. (1989). Assessments of dimensions of childhood firesetting among patients and nonpatients: the Firesetting Risk Interview. Journal of Abnormal Child Psychology. 17(2). 157-176.  McMahon, R. and Frick, P. (2005). Evidence-based assessment of conduct problems in children and adolescents. Journal of Clinical Child and Adolescent Psychology. 34(3). 477-505. Millon, T. (2006). Millon Adolescent Clinical inventory Manual. NCS Pearson Inc. Minneapolis, MN.  Mills, J. (2005). Advances in the assessment and prediction of interpersonal violence. Journal of Interpersonal Violence. 20(2). 236-241. Novaco, R. (2003). The Novaco Anger Scale and Provocation Inventory Manual. Western Psychological Associates. Los Angeles, CA.  Skinner, H., Steinhauer, P. and Santa-Barbara, J. (1995). Family Assessment Measure Version III Technical Manual. Multi-Health Systems. North Tonowanda, NY. Stadolnik, R. (2000). Drawn to the Flame: Assessment and Treatment of Juvenile Firesetting Behavior. Professional Resource Press. Sarasota, FL.  Wilcox, D. (2006). Assessing Firesetting Behavior in Children and Adolescents. In Forensic Mental Health Assessments of Children and Adolescents (Sparta, S. & Koocher, G. Eds.). Oxford University Press, New York, NY. B. Jackson, Ph.D. & R. Stadolnik, Ed.D.

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