The contribution of psychological assessment to community mental health services

Specialist psychological assessment plays a potentially important role in multidisciplinary community mental health settings. This portfolio describes and evaluates this psychological assessment and provides four case studies.

Assessment and case conceptualization in sex offender treatment

The assessment of sexual offenders consists of the systematic collection of clinically relevant information in order to detect clinical phenomena or problems and to provide clear treatment targets. The result of this process is a conceptual model, or case formulation, representing the client’s various problems, the hypothesized underlying mechanisms, and their interrelationships. The focus of this article is on the importance of psychological assessment and case formulation in the rehabilitation and management of individuals convicted of sexual offences. First, we make a number of general points about the importance of evidence based assessment and clinical reasoning in case formulation. Second, we review key elements of contemporary sexual offender theory that highlights the heterogeneity evident among sex offenders and the implications for case formulation and treatment planning. Third, we discuss the role of case formulation for risk assessment and management. Finally, we illustrate our major points with a brief case study and conclude with a brief consideration of the value of case formulations.

The diagnostic validity and reliability of an internet-based clinical assessment program for mental disorders

BACKGROUND: Internet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders. OBJECTIVE: The aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system. METHODS: Participants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion. RESULTS: With structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder: κ=.37) to strong (eg, panic disorder: κ=.62). Although the e-PASS' sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia: κ=.54) to substantial (eg, bulimia nervosa: κ=.87). CONCLUSIONS: The e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).

How deinstitutionalisation and the current public mental health system affects individuals with schizophrenia : four case reports

The professional component of this thesis focuses on how deinstitutionalisation and the current public mental health system have affected individuals with schizophrenia. Chapter one discusses the process of deinstitutionalisation and the research that has examined the impact of this initiative. Chapter two concentrates on schizophrenia, specifically the symptoms, course, etiological theories and treatments of this illness. Four case studies are then provided in order to explore how deinstitutionalisation and the current mental health system have affected individuals with schizophrenia. The names and identifying characteristics of these clients and their families have been modified to ensure anonymity. Chapter three describes a 47 year old woman, AA, who was referred for a neuro-psychological assessment. Chapter four outlines the second case study, a 23 year old male, BB, who was referred for a psychological assessment regarding diagnosis and treatment recommendations. Chapter five describes the third case study, a 54 year old woman, CC, who was referred for therapy and consultation regarding future treatment recommendations. Chapter six discusses the fourth case study, a 21 year old male, DD, who was seen for crisis intervention and treated in the community. Each of these case studies outlines the background history, formulation and treatment approaches. These case reports are used to illustrate how deinstitutionalisation and the present public mental health system affect individuals with schizophrenia. Chapter seven provides an overall discussion and conclusion to these case studies.

Assessing adult adjustment to relationship separation : the Psychological Adjustment to Separation Test (PAST)

Relationship separation is associated with substantial adult adjustment problems. The Psychological Adjustment to Separation Test (PAST) was developed as a self-report measure of 3 key dimensions of separation adjustment problems: lonely negativity, ex-partner attachment and coparenting conflict. Two independent samples (n = 219 and n = 169, respectively) of recently separated adults, 60% of whom had children, completed the PAST and other measures of general adjustment. Exploratory and confirmatory factor analyses demonstrated a replicable 3-factor structure, with each factor showing satisfactory test–retest and internal reliability and good convergent and discriminant validity. The PAST meets initial criteria for a potentially useful new measure of adult separation adjustment.

Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder

Objective: To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]).

Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filters ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs).

Results: Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater.

Conclusions: Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.

The child initiated pretend play assessment (ChIPPA) [kit]

"Assesses the spontaneous ability of children to organise their play and to pretend in play. Suitable for children who are developmentally delayed, are at risk of learning problems, have a specific diagnosis such as Downs Syndrome, Autism Spectrum Disorder, or Attention Deficit Hyperactive Disorder. Also suitable for children who have a physical disability and children who have been traumatized/neglected. Can be used in clinical settings, preschools, schools, early childhood settings and home"

The relationship between childhood cruelty to animals and psychological adjustment : a Malaysian study

In Western research, cruelty to animals in childhood has been associated with comorbid conduct problems and with interpersonal violence in later life. However, there is little understanding of the etiology of cruelty to animals, and what in the child's life may require attention if the chain linking animal cruelty and later violence is to be broken. The study reported in this paper investigated the association between parent-reported cruelty to animals, and parent- and self-reported psychological strengths and weaknesses in a sample of 379 elementary school children in an Eastern context, Malaysia. No gender differences were found in relation to cruelty to animals or psychological problems, as assessed with the Strengths and Difficulties Questionnaire (SDQ). However, there were different predictors of cruelty to animals for boys and girls. Regression analyses found that for boys, parent-reported hyperactivity was a unique predictor of Malicious and Total Cruelty to animals. For girls, self-reported conduct problems was a unique predictor of Typical Cruelty to animals. Parent-reported total difficulties were associated with Typical, Malicious, and Total Cruelty to animals. We suggest that routine screening of children with an instrument such as the SDQ may help to detect those children who may need to undergo further assessment and perhaps intervention to break the chain linking childhood cruelty to animals and later conduct problems.

Sex offender risk assessment : consideration of human rights in community protection legislation

ObjectivesRisk assessments provided to judicial decision makers as a part of the current generation of legislation for protecting the public from sexual offenders can have a profound impact on the rights of individual offenders. This article will identify some of the human rights issues inherent in using the current assessment procedures to formulate and communicate risk as a forensic expert in cases involving civil commitment, preventive detention, extended supervision, or special conditions of parole. MethodBased on the current professional literature and applied experience in legal proceedings under community protection laws in the United States and New Zealand, potential threats to the rights of offenders are identified. Central to these considerations are issues of the accuracy of current risk assessment measures, communicating the findings of risk assessment appropriately to the court, and the availability of competent forensic mental health professionals in carrying out these functions. The role of the forensic expert is discussed in light of the competing demands of protecting individual human rights and community protection. ConclusionActuarial risk assessment represents the best practice for informing judicial decision makers in cases involving sex offenders, yet these measures currently demonstrate substantial limitations in predictive accuracy when applied to individual offenders. These limitations must be clearly articulated when reporting risk assessment findings. Sufficient risk assessment expertise should be available to provide a balanced application of community protection laws.

Histological assessment of intermediate - and long-term creatine monohydrate supplementation in mice and rats

Creatine monohydrate (CrM) supplementation appears to be relatively safe based on data from short-term and intermediate-term human studies and results from several therapeutic trials. The purpose of the current study was to characterize pathological changes after intermediate-term and long-term CrM supplementation in mice [healthy control and SOD1 (G93A) transgenic] and rats (prednisolone and nonprednisolone treated). Histological assessment (18-20 organs/tissues) was performed on G93A mice after 159 days, and in Sprague-Dawley rats after 365 days, of CrM supplementation (2% wt/wt) compared with control feed. Liver histology was also evaluated in CD-1 mice after 300 days of low-dose CrM supplementation (0.025 and 0.05 g · kg^-1 · day^-1) and in Sprague-Dawley rats after 52 days of CrM supplementation (2% wt/wt) with and without prednisolone. Areas of hepatitis were observed in the livers of the CrM-supplemented G93A mice (P < 0.05), with no significant inflammatory lesions in any of the other 18-20 tissues/organs that were evaluated. The CD-1 mice also showed significant hepatic inflammatory lesions (P < 0.05), yet there was no negative effect of CrM on liver histology in the Sprague-Dawley rats after intermediate-term or long-term supplementation nor was inflammation seen in any other tissues/organs (P = not significant). Dietary CrM supplementation can induce inflammatory changes in the liver of mice, but not rats. The observed inflammatory changes in the murine liver must be considered in the evaluation of hepatic metabolism in CrM-supplemented mice. Species differences must be considered in the evaluation of toxicological and physiological studies.

An interview schedule for use in the assessment of tertiary students' learning development needs

The initial interview is an important aspect of development of and intervention in tertiary student learning. Yet there are no published interview schedules available to psychologists working in the area of tertiary academic skills development. This paper presents an interview schedule for use with individual tertiary students seeking assistance with learning and academic skills development. Some preliminary comments about the application of the schedule are also offered.