Assessment tools for mental health counselors

Early in treatment, screen all clients who have histories of exposure to traumatic events for psychological symptoms and mental disorders related to trauma. Be aware that some clients will not make the connection between trauma in their histories and their current patterns of behavior e. Consider using paper-and-pencil instruments for screening and assessment as well as self-report measures when appropriate; they are less threatening for some clients than a clinical interview.

Timing of Screening and Assessment As a trauma-informed counselor, you need to offer psychoeducation and support from the outset of service provision; this begins with explaining screening and assessment and with proper pacing of the initial intake and evaluation process.

Clients with substance use disorders No screening or assessment of trauma should occur when the client is under the influence of alcohol or drugs. Conduct Assessments Throughout Treatment Ongoing assessments let counselors: Track changes in the presence, frequency, and intensity of symptoms. The Setting for Trauma Screening and Assessment Advances in the development of simple, brief, and public-domain screening tools mean that at least a basic screening for trauma can be done in almost any setting.

Creating an effective screening and assessment environment You can greatly enhance the success of treatment by paying careful attention to how you approach the screening and assessment process.

Take into account the following points: Clarify for the client what to expect in the screening and assessment process. For example, tell the client that the screening and assessment phase focuses on identifying issues that might benefit from treatment. Inform him or her that during the trauma screening and assessment process, uncomfortable thoughts and feelings can arise.

Approach the client in a matter-of-fact, yet supportive, manner. Doing so helps to normalize symptoms and experiences generated by the trauma; consider informing clients that such events are common but can cause continued emotional distress if they are not treated. Clients may also find it helpful for you to explain the purpose of certain difficult questions. Cultural and ethnic factors vary greatly regarding the appropriate physical distance to maintain during the interview.

Clients with trauma may have particular sensitivity about their bodies, personal space, and boundaries. Strive to maintain a soothing, quiet demeanor. Be sensitive to how the client might hear what you have to say in response to personal disclosures.

Clients who have been traumatized may be more reactive even to benign or well-intended questions. Provide culturally appropriate symbols of safety in the physical environment.

These include paintings, posters, pottery, and other room decorations that symbolize the safety of the surroundings to the client population. Avoid culturally inappropriate or insensitive items in the physical environment. It is important for you to monitor your interactions and to check in with the client as necessary. You may also feel emotionally drained to the point that it interferes with your ability to accurately listen to or assess clients.

This effect of exposure to traumatic stories, known as secondary traumatization, can result in symptoms similar to those experienced by the client e. Overcome linguistic barriers via an interpreter. Deciding when to add an interpreter requires careful judgment.

The interpreter should be knowledgeable of behavioral health terminology, be familiar with the concepts and purposes of the interview and treatment programming, be unknown to the client, and be part of the treatment team. Avoid asking family members or friends of the client to serve as interpreters. Elicit only the information necessary for determining a history of trauma and the possible existence and extent of traumatic stress symptoms and related disorders.

Given the lack of a therapeutic relationship in which to process the information safely, pursuing details of trauma can cause retraumatization or produce a level of response that neither you nor your client is prepared to handle.

Your tone of voice when suggesting postponement of a discussion of trauma is very important. Use self-administered, written checklists rather than interviews when possible to assess trauma. Traumas can evoke shame, guilt, anger, or other intense feelings that can make it difficult for the client to report them aloud to an interviewer.

Clients are more likely to report trauma when they use self-administered screening tools; however, these types of screening instruments only guide the next step. Interviews should coincide with self-administered tools to create a sense of safety for the client someone is present as he or she completes the screening and to follow up with more indepth data gathering after a self-administered screening is complete.

Interview the client if he or she has trouble reading or writing or is otherwise unable to complete a checklist.

Clients who are likely to minimize their trauma when using a checklist e. A trained interviewer can elicit information that a self-administered checklist does not capture. Overall, using both a self-administered questionnaire and an interview can help achieve greater clarity and context. Allow time for the client to become calm and oriented to the present if he or she has very intense emotional responses when recalling or acknowledging a trauma.

If the client has difficulty self-soothing, guide him or her through grounding techniques Exhibit 1. Avoid phrases that imply judgment about the trauma.

Provide feedback about the results of the screening. Present results in a synthesized manner, avoiding complicated, overly scientific jargon or explanations. Allow time to process client reactions during the feedback session. Answer client questions and concerns in a direct, honest, and compassionate manner. Be aware of the possible legal implications of assessment. Information you gather during the screening and assessment process can necessitate mandatory reporting to authorities, even when the client does not want such information disclosed Najavits, Other legal issues can be quite complex, such as confidentiality of records, pursuing a case against a trauma perpetrator and divulging information to third parties while still protecting the legal status of information used in prosecution, and child custody issues Najavits, Barriers and Challenges to Trauma-Informed Screening and Assessment Barriers It is not necessarily easy or obvious to identify an individual who has survived trauma without screening.

A belief that treatment of substance abuse issues needs to occur first and exclusively, before treating other behavioral health disorders. A belief that treatment should focus solely on presenting symptoms rather than exploring the potential origins or aggravators of symptoms.

Not using common language with clients that will elicit a report of trauma e. Not recalling past trauma through dissociation, denial, or repression although genuine blockage of all trauma memory is rare among trauma survivors; McNally, Challenges Awareness of acculturation and language Acculturation levels can affect screening and assessment results. Common Assessment Myths Several common myths contribute to underassessment of trauma-related disorders Najavits, : Myth 1: Substance abuse itself is a trauma.

Nevertheless, high-risk behaviors that are more likely to occur during addiction, such as interpersonal violence and self-harm, significantly increase the potential for traumatic injury. Myth 2: Assessment of trauma is enough. Thorough assessment is the best way to identify the existence and extent of trauma-related problems. However, simply identifying trauma-related symptoms and disorders is just the first step. Also needed are individualized treatment protocols and action to implement these protocols.

Myth 3: It is best to wait until the client has ended substance use and withdrawal to assess for PTSD. Research does not provide a clear answer to the controversial question of when to assess for PTSD; however, Najavits and others note that underdiagnosis of trauma and PTSD has been more significant in the substance abuse field than overdiagnosis. Clinical experience shows that the PTSD diagnosis is rather stable during substance use or withdrawal, but symptoms can become more or less intense; memory impairment from alcohol or drugs can also cloud the symptom picture.

Thus, it is advisable to establish a tentative diagnosis and then reassess after a period of abstinence, if possible. Awareness of co-occurring diagnoses A trauma-informed assessor looks for psychological symptoms that are associated with trauma or simply occur alongside it. Misdiagnosis and underdiagnosis Many trauma survivors are either misdiagnosed i. Some of the most common misdiagnoses in clients with PTSD and substance abuse are: Mood and anxiety disorders.

Overlapping symptoms with such disorders as major depression, generalized anxiety disorder, and bipolar disorder can lead to misdiagnosis. Borderline personality disorder. Historically, this has been more frequently diagnosed than PTSD.

Many of the symptoms, including a pattern of intense interpersonal relationships, impulsivity, rapid and unpredictable mood swings, power struggles in the treatment environment, underlying anxiety and depressive symptoms, and transient, stress-related paranoid ideation or severe dissociative symptoms overlap.

The effect of this misdiagnosis on treatment can be particularly negative; counselors often view clients with a borderline personality diagnosis as difficult to treat and unresponsive to treatment. Antisocial personality disorder. Attention deficit hyperactivity disorder ADHD. Cultural factors, such as norms for expressing psychological distress, defining trauma, and seeking help in dealing with trauma, can affect: How traumas are experienced.

How trauma-related symptoms are expressed e. Willingness to express distress or identify trauma with a behavioral health service provider and sense of safety in doing so. Whether a specific pattern of behavior, emotional expression, or cognitive process is considered abnormal. Cultural concepts of distress include: Ataques de nervios. Recognized in Latin America and among individuals of Latino descent, the primary features of this syndrome include intense emotional upset e. It frequently occurs in response to a traumatic or stressful event in the family.

This is considered a common idiom of distress among Latinos; it includes a wide range of emotional distress symptoms including headaches, nervousness, tearfulness, stomach discomfort, difficulty sleeping, and dizziness. Symptoms can vary widely in intensity, as can impairment from them.

This often occurs in response to stressful or difficult life events. Susto is attributed to a traumatic or frightening event that causes the soul to leave the body, thus resulting in illness and unhappiness; extreme cases may result in death.

Symptoms include appetite or sleep disturbances, sadness, lack of motivation, low self-esteem, and somatic symptoms. Taijin kyofusho. The individual presents worry or a conviction that his or her appearance or social interactions are inadequate or offensive. To the best of our knowledge the assessment measures listed here are either free of copyright restrictions, or are being shared by the relevant rights-holders.

Mental health professionals use a variety of instruments to assess mental health and wellbeing. Common purposes for psychological testing include: screening for the presence or absence of common mental health conditions; making a formal diagnosis of a mental health condition; assessment of changes in symptom severity; and monitoring client outcomes across the course of therapy. Screening measures are often questionnaires completed by clients.

Screening tends are quick to administer but results are only indicative: if a positive result is found on a screening test then the screening test can be followed up by a more definitive test. Diagnosis: Psychological assessment measures can support a qualified clinician in making a formal diagnosis of a mental health problem.

Mental health screenings are informal symptom checks. They're typically checklists or questionnaires that ask people to consider their symptoms and either indicate that yes, they experience a given symptom, or no, they do not experience said symptom. Many prompt the test-taker to rate the degree of severity for each symptom he or she is experiencing.

Screening tests don't diagnose mental disorders. Instead, they're powerful tools for beginning to fully understand your mental health, to decide if you should see a mental health professional, and to figure out what you'd like to improve. Additionally, mental health screening tests allow people of all ages to identify and discuss problems before they spiral down and out of control. Many times, these are free of charge.

For the tech-savvy, screening apps are available for smartphones, and online psychological tests allow people to complete screenings on their own computer. Here are links to various screening tests on HealthyPlace.

Screening is a type of mental health assessment, one completed very early in the therapeutic process. Other assessments, sometimes called measurements, appraisals, or tests, take place throughout the process.

In general, mental health assessments are used for:. Assessment can be informal or formal, standardized or non-standardized, self-report or therapist-administered. It can be conducted at any stage of the counseling process prior to beginning, beginning, middle, end, and throughout the entire process. Indeed, there are many ways for people to come to understand what's happening related to their mental health as well as the scope of the trouble.