Exhaustive Guide to Clinical Assessment and Testing in Counseling

Introduction to Assessment and Evaluative Procedures

  • Definition of Assessment: This refers to the systematic process of gathering and documenting information regarding a client’s knowledge, skills, attitudes, and/or beliefs. It is a core area of counselor preparation involving the review, selection, administration, and interpretation of evaluative procedures.
  • Domain Representation on the National Counselor Examination (NCE):
    • Scored items: 20 out of 160 (12.5%).
    • Rank: 3.5 out of 8 (average number of items across domains).
    • Average item difficulty index: 0.710.71 (ranked 5th easiest/4th most difficult).
    • Meaning: 71% of test-takers answer items in this domain correctly.
  • Domain Representation on the Counselor Preparation Comprehensive Exam (CPCE):
    • Scored items: 17 (plus trial items).
    • Average item difficulty index: 0.620.62.
    • Meaning: 62% of test-takers answer correctly, making it one of the more challenging sets on the exam.
  • CACREP (2009) Standards for Assessment: These standards provide an understanding of individual and group approaches to evaluation in a multicultural society, including:
    • Historical perspectives on the nature and meaning of assessment.
    • Basic concepts of standardized vs. nonstandardized testing, norm-referenced vs. criterion-referenced assessment, environmental and performance assessment, individual/group test and inventory methods, psychological testing, and behavioral observations.
    • Statistical concepts: scales of measurement, central tendency, variability, distribution shapes/types, and correlations.
    • Reliability: theory of measurement error, reliability models, and use of reliability data.
    • Validity: types of validity, evidence, and the relationship between reliability and validity.
    • Social and cultural factors related to assessing individuals, groups, and specific populations.
    • Ethical strategies for selection, administration, and interpretation of instruments.
  • Broad Categories of Evaluative Procedures (Table 7.1):
    • Clinical Interviewing: Structured, semi-structured, and unstructured.
    • Informal Assessment: Observation of behavior, rating scales, classification techniques, records, and personal documents.
    • Personality Assessment: Standardized tests (e.g., MMPI), projective tests (e.g., TAT), and interest inventories (e.g., Strong Interest Inventory).
    • Ability Assessment: Achievement tests (e.g., WRAT), aptitude tests (e.g., SAT), and intelligence tests (e.g., WISC).

Key Historical Events and Pioneers in Assessment

  • Ancient China (2300 B.C.E.): Credited with the first widely used tests; physical fitness tests were used by the government to screen candidates for civil service positions.
  • 19th-Century Pioneers (Table 7.2):
    • Jean Esquirol (1772–1840): Used language development to identify levels of intelligence; forerunner of verbal IQ. Recognized mental retardation as developmental rather than mental illness.
    • Edouard Seguin (1812–1880): Developed the form board to improve motor skills; predecessor to performance IQ testing.
    • Sir Francis Galton (1822–1911): Launched the testing movement; developed the first intelligence test. Pioneered rating scales/questionnaires and developed the correlation coefficient (rr).
    • William Wundt (1832–1920): Founded one of the first psychological laboratories for experimental research.
    • James Cattell (1860–1944): Applied statistical concepts to assessment; popularized the term "mental test."
    • Hermann Ebbinghaus (1850–1909): Studied the forgetting curve and memory; used sentence completion tests to predict scholastic achievement.
  • 20th-Century Developments (Table 7.3):
    • Alfred Binet (1875–1911): Developed the Binet-Simon scale, the first modern intelligence test.
    • Lewis Terman (1877–1956): Revised the Binet-Simon into the Stanford-Binet. Introduced the ratio IQ: Ratio IQ=Mental AgeChronological Age×100\text{Ratio IQ} = \frac{\text{Mental Age}}{\text{Chronological Age}} \times 100.
    • Arthur Otis (1886–1964): Devised the first scientifically reliable group intelligence measure (Otis Group Intelligence Scale).
    • Robert Yerkes (1876–1956): Developed the Army Alpha (cognitive screening for recruits) and Army Beta (language-free version for non-readers or foreign-born).
    • Charles Spearman (1863–1945) & L. L. Thurston (1887–1955): Developed factor analysis, leading to multiple aptitude testing.
    • James Bryant Conant (1893–1978): Developed the Scholastic Aptitude Test (SAT) with ETS to decrease social class disparity.
    • Edward Thorndike (1874–1949): Developed the first objective achievement test battery, the Stanford Achievement Test (SAT).
    • Robert Sessions Woodworth (1896–1962): Created Woodworth’s Personal Data Sheet for WWI recruits, the first standardized personality inventory.
    • Starke Hathaway (1903–1984) & J. Charnley McKinley (1891–1950): Developed the Minnesota Multiphasic Personality Inventory (MMPI).
    • Projective Techniques: Developed by Carl Jung (word associations), Herman Rorschach (inkblots), and Henry Murray (Thematic Apperception Test).
    • Frank Parsons (1854–1908): Father of vocational guidance; lead to vocational and interest inventories.
    • Edward Strong (1884–1963): Devised the Strong Vocational Interest Blank (now Strong Interest Inventory), a staple in career counseling.

Assessment Terminology and Classifications

  • Measurement: Process of defining and estimating the magnitude of human attributes based on three assumptions:
    1. Attributes and behavior are distinct enough to be quantified.
    2. Attributes are present in all people.
    3. Presence/absence indicates normalcy or deficiency.
  • Assessment vs. Test: Assessment is the broad systematic process; a test is a specific subset used to yield data via responses to items.
  • Interpretation: Assigning meaning to data (peer comparison, standards, or professional judgment).
  • Evaluation: Determining worth or significance (e.g., assessing if a client’s monthly Beck Depression Inventory scores show progress).
  • Types of Test Formats:
    • Power Tests: Include difficult items few can answer; focus on ability regardless of time.
    • Speed Tests: Easy items but very limited time; assess response speed.
    • Maximal Performance: Goal is to find the best possible score (e.g., achievement/aptitude tests).
    • Typical Performance: Assesses characteristic or normal traits (e.g., personality inventories).
    • Standardized Tests: Consistent administration/scoring; empirical validation allow peer/norm group comparison (e.g., SAT, GRE).
    • Nonstandardized Tests: Allow for variability; rely on counselor judgment; no norm group (e.g., Rorschach).
    • Individual vs. Group Tests: Individual tests allow rapport and monitoring (fatigue/anxiety) but are costly and time-consuming. Group tests are economical and objective but restricted/inflexible.
    • Objective vs. Subjective: Objective tests have correct answers (T/F, Multiple Choice). Subjective tests involve rater belief and open-ended questions (Essays).

Functions of Assessment in Counseling

  • Diagnosis and Treatment Planning: Gathering symptom data to diagnose (using systems like the DSM−5DSM-5) and plan interventions.
  • Placement Services: Determining appropriate environments (e.g., mainstream vs. special education).
  • Admission: Determining entry into educational institutions (e.g., GRE for graduate school).
  • Selection: Identifying candidates for specific jobs or programs.
  • Monitoring Client Progress: Evaluated throughout counseling via formal (BDI-II) or informal (rating scales 1 to 101 \text{ to } 10) methods.
  • Outcome Research: Evaluating effectiveness. Whiston’s (2013) five-step process:
    1. Define focus (service, treatment, or program).
    2. Determine design (e.g., pretest-intervention-posttest).
    3. Select participants (random, whole population, or subsection).
    4. Select assessments (valid/reliable instruments or study-specific surveys).
    5. Analyze data (quantitative significance or qualitative themes).

Ethical and Legal Issues in Assessment

  • Ethical Codes (ACA and NBCC):
    • Competence: Only use instruments you are trained and competent to use.
    • Informed Consent: Explain nature, purpose, and result uses prior to testing.
    • Release of Results: Only to qualified professionals; require client consent (including identifying info).
    • Instrument Selection: Ensure validity, reliability, psychometric limits, and multicultural appropriateness.
    • Scoring and Interpretation: Document concerns regarding validity due to conditions or norms.
    • Assessment Construction: Use scientific methodology and provide user benefits/limitations.
  • Standards of Practice:
    • Standards for Educational and Psychological Testing: Developed by AERA, APA, and NCME. Covers Test Construction, Fairness, and Applications.
    • Responsibilities of Users of Standardized Tests (RUST): AARC policy ensuring accurate/fair test use.
    • Joint Committee on Testing Practices (JCTP): Published "Rights and Responsibilities of Test Takers," "Test User Qualifications," and the "Code for Fair Testing Practices in Education."
  • Public Laws:
    • Civil Rights Act (1964): Employment tests must be job-related.
    • FERPA (1974): Confidentiality of student records; parent/student right to view.
    • IDEA (2004): Right to free testing for suspected disabilities; mandates IEPs.
    • Carl D. Perkins Act (1984): Vocational assessment access for the disadvantaged/English language learners.
    • Americans with Disabilities Act (1990): Mandatory accommodations during testing.
    • HIPAA (1996): Privacy/consent for medical/mental health records.
    • No Child Left Behind (2001): Mandated basic skills assessments in schools.
  • Lynchpin Court Cases:
    • Larry P. v. Riles: Prohibited biased IQ tests for African American students.
    • Diana v. California: Testing must be in the student's first language and English.
    • Sharif v. New York State Ed Dept: SAT scores alone cannot determine scholarships.
    • Griggs v. Duke Power: Job tests must be strictly job-related.
    • Soroka v. Dayton-Hudson Co: Pre-employment psychological screening can be an invasion of privacy.

Information Sources for Assessments

  • Mental Measurements Yearbook (MMY): The premier source for English-language assessments. Includes acronyms, publishers, price, reliability/validity, and expert critiques.
  • Tests in Print (TIP): Companion to MMY; comprehensive list of all published tests but lacks críticas/psychometrics.
  • Tests: Concise descriptions of thousands of tests (education, business, psychology); no critiques or reliability data.
  • Test Critiques: Companion to "Tests"; includes comprehensive expert reviews (8 pages on average) and user-friendly language.

Principles of Test Construction: Validity

  • Definition: How accurately an instrument measures a given construct (Validity is a property of the scores, not the instrumentValidity \text{ is a property of the scores, not the instrument}).
  • Types of Validity:
    • Content Validity: Extent content reflects the domain (e.g., depression test must include physical, psychological, and cognitive items).
    • Criterion Validity: Predicting performance on a specific criterion.
      • Concurrent: Instrument results and criterion data collected simultaneously.
      • Predictive: Instrument correlates with a future criterion (e.g., SAT predicting college GPA).
    • Construct Validity: Measuring a theoretical construct (personality, intelligence).
      • Experimental Design: Pretest/posttest logic.
      • Factor Analysis: Statistical analysis of subscales to the larger construct.
      • Convergent: High correlation with existing similar measures.
      • Discriminant: No correlation with dissimilar measures.
    • Face Validity: Superficial credibility; not a formal statistical validity.
  • Reporting Validity: Expressed as a correlation coefficient or a regression equation.
    • Standard Error of Estimate: Expected margin of error in predicted scores: sest=∑(Y−Y′)2Ns_{est} = \sqrt{\frac{\sum(Y - Y')^2}{N}}.
  • Decision Accuracy:
    • Sensitivity: Identifying the presence of a phenomenon.
    • Specificity: Identifying the absence of a phenomenon.
    • False Positive Error: Inaccurately identifying presence.
    • False Negative Error: Inaccurately identifying absence.
    • Incremental Validity: How much an instrument adds to prediction accuracy.

Principles of Test Construction: Reliability

  • Definition: Consistency of scores across administrations.
  • Classical Test Theory Equation: X=T+eX = T + e (Observed Score = True Score + Error).
  • Estimation Methods:
    • Test-retest (Temporal Stability): Administering the same test twice over time.
    • Alternative Form (Parallel/Equivalent): Comparing two different but equal forms.
    • Internal Consistency: item-to-item consistency.
      • Split-half: Correlating halves. Uses Spearman-Brown Prophecy Formula: 2rhh1+rhh\frac{2r_{hh}}{1 + r_{hh}}.
      • Inter-item Consistency: Kuder-Richardson 20 (dichotomous items) and Cronbach’s Coefficient Alpha (multipoint/Likert scales).
    • Inter-scorer (Inter-rater): Consistency between different scorers.
  • Standard Error of Measurement (SEM): Estimates score distribution around the true score. Inverse to reliability: SEM=SD1−rttSEM = SD \sqrt{1 - r_{tt}}.
    • 68%68\% Confidence: ±1 SEM\pm 1 \text{ SEM}.
    • 95%95\% Confidence: ±2 SEM\pm 2 \text{ SEM}.
    • 99.7%99.7\% Confidence: ±3 SEM\pm 3 \text{ SEM}.
  • Influences on Reliability: Test length (longer is better), homogeneity of items, range restriction (lowers reliability), and speed tests (produce spuriously high reliability).

Item Analysis and Test Theory

  • Item Difficulty: The decimal percentage (pp value) of test-takers answering correctly. Range: 0 to 1.00 \text{ to } 1.0. Optimal average is 0.500.50.
  • Item Discrimination: Ability of an item to differentiate between high and low scorers. Positive discrimination (more upper-group correct than lower-group) is preferred.
  • Item Response Theory (IRT): Modern theory using mathematical models to evaluate item bias, equate scores, and tailor tests to individuals.
  • Construct-Based Validity Model (Messick): Proposes validity is holistic, not just separate components.

Scales of Measurement and Types of Scales

  • Scales of Measurement:
    1. Nominal: Classification only (e.g., Male = 0, Female = 1).
    2. Ordinal: Rank-order; intervals not equal (e.g., Satisfaction ratings).
    3. Interval: Equal intervals; no absolute zero (e.g., Fahrenheit; most psychological tests).
    4. Ratio: Equal intervals plus absolute zero; can quantify absolute terms (e.g., height, weight, time).
  • Types of Scales:
    • Likert-type: Range from Strongly Agree to Strongly Disagree.
    • Semantic Differential (Self-anchored): Based on dichotomous thinking (e.g., Good ---------- Bad).
    • Thurstone: Successive intervals; paired comparison method.
    • Guttman: Progressive order; agreement with extreme items implies agreement with all preceding milder items.

Derived Scores and the Normal Distribution

  • Normal Distribution (Bell Curve): Symmetrical, asymptotic (tails never touch the axis). Mean, median, and mode are identical and centered.
  • Criterion-Referenced: Comparison to a fixed standard (e.g., NCE passing score).
  • Ipsative Assessment: Self-referenced comparison (previous score vs. current score).
  • Norm-Referenced: Comparison to the average of a group.
  • Types of Standardized Scores:
    • Percentile Rank: Percentage of scores falling at or below a score (Range: 1−991-99; Mean = 5050).
    • z-score: The base standard score. Mean = 00, SD = 11. Formula: z=X−MSDz = \frac{X - M}{SD}.
    • T score: Used in personality/interest tests. Mean = 5050, SD = 1010. Formula: T=10(z)+50T = 10(z) + 50.
    • Deviation IQ: Mean = 100100, SD = 1515. Formula: SS=15(z)+100SS = 15(z) + 100.
    • Stanine: "Standard Nine." Mean = 55, SD = 22. Range: 1−91-9. Formula: Stanine=2(z)+5Stanine = 2(z) + 5 (round to nearest whole number).
    • Normal Curve Equivalent (NCE): Mean = 5050, SD = 21.0621.06. Formula: NCE=21.06(z)+50NCE = 21.06(z) + 50. Range: 1−991-99.
  • Developmental Scores:
    • Age-equivalent: E.g., 8.28.2 (8 years, 2 months).
    • Grade-equivalent: E.g., 5.65.6 (5th grade, 6th month).

Assessment of Ability

  • Achievement Tests (Table 7.8 & 7.9):
    • Survey Batteries: SAT 10, Iowa Test of Basic Skills (ITBS), Metropolitan Achievement Test (MAT8), TerraNova (Third Edition).
    • Diagnostic Tests: Wide Range Achievement Test (WRAT4), Key Math 3, Woodcock Johnson III (WJ III ACH), Peabody Individual Achievement Test-Revised (PIAT-R), Test of Adult Basic Education (TABE).
    • Readiness Tests: Determine if skills are sufficient for the next grade level; criticized for cultural bias.
  • Aptitude Tests (Table 7.10):
    • Cognitive Ability: Cognitive Ability Test (CogAT), Otis-Lennon School Ability Test (OLSAT8), ACT, SAT Reasoning Test, GRE, Miller Analogies Test (MAT), LSAT, MCAT.
    • Vocational Aptitude:
      • Multiple: Armed Services Vocational Aptitude Battery (ASVAB - 10 ability tests); Differential Aptitude Test (DAT).
      • Special: Clerical Test Battery (CTB2), Wiesen Test of Mechanical Aptitude, Music Aptitude Profile.
  • Intelligence Theories (Table 7.12):
    • Francis Galton: First theory; heredity and perceptual criticalness.
    • William Stern: Ratio IQ.
    • Charles Spearman: "g" (general factor) and "s" (specific factors).
    • Louis Thurston: 7 primary mental abilities.
    • Raymond Cattell: Fluid intelligence (innate, declines with age) and Crystallized intelligence (learned, increases with age).
    • Howard Gardner: 8 primary intelligences (e.g., musical, intrapersonal, naturalistic).
    • Cattell-Horn-Carroll (CHC): Most empirically validated; 3-stratum hierarchy.
  • Intelligence Tests (Table 7.13): Stanford-Binet 5, Wechsler Scales (WAIS-IV for adults, WISC-IV for kids 6-16, WPPSI-IV for age 2-7), KABC-II.

Clinical and Personality Assessment

  • Objective Personality Tests (Table 7.15):
    • MMPI-2: Identifies psychopathology; contains validity scales (L, K, F, VRIN, TRIN).
    • Millon Clinical Multiaxial Inventory (MCMI-III): Assesses personality disorders (DSM−5DSM-5 Axis II).
    • Myers-Briggs Type Indicator (MBTI): Jungian types; 4 dimensions (E/I, S/N, T/F, J/P).
    • California Psychological Inventory (CPI): For nonpathological, well-adjusted people.
    • 16PF: Raymond Cattell’s 16 traits.
    • NEO PI-3: Big Five factors (Neuroticism, Extroversion, Openness, Agreeableness, Conscientiousness).
  • Projective Personality Tests (Table 7.16): Rorschach (10 inkblots), TAT (31 vague pictures), House-Tree-Person (HTP), Sentence Completion.
  • Informal Techniques:
    • Observation: Direct (Narrative, ABC, Event, Duration, Latency, Interval) and Indirect (Behavioral interviews, checklists).
    • Clinical Interviewing: Structured (consistent but inflexible), Semi-structured (customizable), Unstructured (flexible but unreliable).
    • Rating Scales: Evaluate quantity; can be Broad-band or Narrow-band.
    • Classification Systems: Behavior/feeling checklists, Sociometric instruments (social dynamics), Situational tests (role-play).
  • Mental Status Exam (MSE): Assesses Appearance, Attitude, Movement/Behavior, Mood/Affect, Thought Content, Perceptions, Thought Processes, Judgment/Insight, Intellectual Functioning/Memory.
  • Suicide Assessment: Determining lethality (high, moderate, low).
    • Acronyms: SAV PERSONS (Sex, Age, Depression, Previous attempt, Ethanol abuse, Rational thought loss, Social supports lacking, Organized plan, No spouse, Sickness) and PIMP (Plan, Intent, Means, Prior attempts).
    • Standardized Assessments: Beck Scale for Suicide Ideation, Reasons-for-Living Inventory.

Diversity and Technology in Assessment

  • Types of Bias:
    • Test Bias: Property of test favors one group.
    • Examiner Bias: Examiner beliefs influence administration.
    • Interpretive Bias: Examiner interpretation is unfair.
    • Response Bias: Client answers in a specific set (e.g., all yes).
    • Situational Bias: Environment affects groups differently.
    • Ecological Bias: Systems/theories are culturally misaligned.
  • Test Adaptation vs. Translation: Translation is literal but criticized for cross-cultural equivalence assumptions. Adaptation alters content and language for cultural equivalence (follows ITC guidelines).
  • Computer-Based Testing (CBT):
    • Benefits: Reduced cost/time, high accuracy, quick feedback, standardization, client preference for sensitive topics.
    • Disadvantages: Equipment cost, compatibility issues, lack of standards, minimized human contact.
  • Computer-Adaptive Testing: GRE is a primary example; modifies structure and items based on examinee ability level to reduce time without sacrificing accuracy.

Questions & Discussion (Practice Items)

  • Q1: Developed by Robert Yerkes, the language-free test designed for non-readers/foreign born is the: Army Beta.
  • Q2: School counselor determining grade readiness should use a: maximal performance test.
  • Q3: The Carl D. Perkins Act provides: disadvantaged populations access to vocational services.
  • Q4: Releasing results to a case manager with no assessment training violates: Release of results to qualified professionals.
  • Q5: Source for understandably assessment info for laypeople: Test Critiques.
  • Q6: Formula for interitem consistency of a Likert-scale test: Cronbach’s coefficient alpha.
  • Q7: Positive item discrimination means: more students who knew material well answered correctly than those who didn't.
  • Q8: Sensing vs. Intuition in MBTI measures: How you perceive the world around you.
  • Q9: Which client is MOST likely to commit suicide based on risk: 67-year-old divorced Caucasian male who lost his job and feels hopeless.