Behavioral Assessment and Case Formulation E-Book

Stephen N. Haynes

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 578

Veröffentlichungsjahr: 2011

Beschreibung

Comprehensive, scientifically based coverage on conducting behavioral assessments, analyzing results, and forming clinical recommendations Behavioral Assessment and Case Formulation thoroughly outlines the underlying principles of the behavioral assessment process. This book clearly explains how the principles and methods of behavioral assessment central to the formulation of functional analysis are also helpful in guiding strategies for determining interventions and measuring the processes and outcomes. This comprehensive resource offers up-to-date answers to relevant questions of the clinical assessment process, including: * What is the best assessment strategy to use with a particular client? * Which assessment methods will best capture a client's unique strengths,limitations, behavior problems, and intervention goals? * How can data from multiple sources be integrated in order to yield a valid and clinically useful case formulation? * Which procedures should be enacted in order to insure a positive clinician-client relationship? * How should intervention processes and outcomes be measured and monitored? Filled with case studies, Behavioral Assessment and Case Formulation provides guidelines for the application of behavioral assessment strategies and methods that can strengthen the validity and utility of clinical judgments, as well as improve the delivery of care.

Leseprobe

Contents

Cover

Title Page

Copyright

Dedication

Preface

Chapter 1: Introduction to Behavioral Assessment and Case Formulation

CLINICAL ASSESSMENT AND PSYCHOLOGICAL ASSESSMENT PARADIGMS

EVALUATING PSYCHOLOGICAL ASSESSMENT PARADIGMS

ADOPTING A SCHOLARLY AND SCIENCE-BASED APPROACH TO CLINICAL ASSESSMENT

BEHAVIORAL ASSESSMENT, CLINICAL CASE FORMULATION, AND MEASUREMENT

THE CONTEXT OF CLINICAL CASE FORMULATION: THE CHALLENGE OF MAKING INTERVENTION DECISIONS

THE ROLE OF CLINICAL CASE FORMULATION ACROSS INTERVENTION PARADIGMS

CLINICAL CASE FORMULATION IN BEHAVIOR THERAPY

THE COSTS AND BENEFITS OF CLINICAL CASE FORMULATION

ALTERNATIVE MODELS OF CLINICAL CASE FORMULATION IN COGNITIVE-BEHAVIOR THERAPY

INTRODUCTION TO BASIC CONCEPTS IN BEHAVIORAL ASSESSMENT

SUMMARY

Chapter 2: Introduction to the Functional Analysis as a Paradigm for Behavioral Case Formulation

DEFINITION OF FUNCTIONAL ANALYSIS

MRS. SANCHEZ: A CLINICAL CASE EXAMPLE OF THE FUNCTIONAL ANALYSIS AND FUNCTIONAL ANALYTIC CLINICAL CASE DIAGRAM, AND METHODS OF BEHAVIORAL ASSESSMENT

BRIEF FUNCTIONAL ANALYSIS CASE FORMULATION AND FUNCTIONAL ANALYTIC CLINICAL CASE DIAGRAM

AN OVERVIEW OF THE COMPONENTS OF THE FUNCTIONAL ANALYSIS AND FUNCTIONAL ANALYTIC CLINICAL CASE DIAGRAM

ADDITIONAL CHARACTERISTICS OF THE FUNCTIONAL ANALYSIS

SUMMARY

Chapter 3: Illustrating the Functional Analysis With Functional Analytic Clinical Case Diagrams

INTRODUCTION TO THE FUNCTIONAL ANALYTIC CLINICAL CASE DIAGRAM

INTRODUCTION TO CAUSAL DIAGRAMS

ILLUSTRATING THE ELEMENTS OF A FUNCTIONAL ANALYSIS IN A FUNCTIONAL ANALYTIC CLINICAL CASE DIAGRAM

EXAMPLES OF CAUSAL DIAGRAMS APPLIED TO THE FUNCTIONAL ANALYSIS: EXAMPLES OF THE FACCD

BENEFITS AND GOALS OF FACCDs

LIMITATIONS OF THE FUNCTIONAL ANALYSIS AND OF FACCDs

SUMMARY

Chapter 4: Conceptual and Empirical Foundations of Behavioral Assessment and the Functional Analysis I

CHAPTER OVERVIEW

OVERVIEW OF THE COMPLEX NATURE OF BEHAVIOR PROBLEMS

WHY A FOCUS ON BEHAVIOR PROBLEMS RATHER THAN BEHAVIOR DISORDERS?

CLIENTS OFTEN HAVE MULTIPLE BEHAVIOR PROBLEMS

WHY DO CLIENTS HAVE MULTIPLE BEHAVIOR PROBLEMS?

BEHAVIOR PROBLEMS CAN HAVE IMPORTANT FUNCTIONAL INTERRELATIONS

BEHAVIOR PROBLEMS DIFFER IN THEIR IMPORTANCE

BEHAVIOR PROBLEMS HAVE MULTIPLE RESPONSE MODES

BEHAVIOR PROBLEMS HAVE MULTIPLE DIMENSIONS

BEHAVIOR PROBLEMS ARE CONDITIONAL

THE DYNAMIC NATURE OF BEHAVIOR PROBLEMS

SUMMARY

Chapter 5: Conceptual and Empirical Foundations of Behavioral Assessment and the Functional Analysis II

INTRODUCTION TO BASIC CONCEPTS OF CAUSALITY

DIVERSE CONCEPTS OF CAUSALITY

NECESSARY CONDITIONS FOR INFERRING A CAUSAL RELATION IN BEHAVIORAL ASSESSMENT, PSYCHOPATHOLOGY, AND THE FUNCTIONAL ANALYSIS

LOGICAL CONNECTIONS BETWEEN VARIABLES

MECHANISMS OF CAUSAL RELATIONS

THE ROLE OF THE CLINICIAN IN CAUSAL INFERENCE

SUMMARY

Chapter 6: Conceptual and Empirical Foundations of Behavioral Assessment and the Functional Analysis III

INTRODUCTION TO BASIC CONCEPTS OF CAUSALITY IN BEHAVIORAL ASSESSMENT

CAUSAL VARIABLES FOR BEHAVIOR PROBLEMS HAVE MULTIPLE ATTRIBUTES

BEHAVIOR PROBLEMS CAN BE AFFECTED BY MULTIPLE CAUSAL VARIABLES

MULTIPLE CAUSAL PATHS CAN EMANATE FROM A SINGLE CAUSAL VARIABLE

INDIVIDUAL DIFFERENCES IN CAUSAL RELATIONS FOR CLIENTS’ BEHAVIOR PROBLEMS

THE DYNAMIC NATURE OF CAUSAL VARIABLES AND CAUSAL RELATIONS

NONLINEAR CAUSAL RELATIONS

WHAT ARE THE MOST USEFUL TYPES OF CAUSAL VARIABLES AND CAUSAL RELATIONS IN THE FUNCTIONAL ANALYSIS?

SITUATIONS, CONTEXTUAL AND SETTING EVENTS, AND SYSTEMS FACTORS AS CAUSAL VARIABLES

AN EMPHASIS ON MODIFIABLE CAUSAL VARIABLES

SUMMARY

Chapter 7: Principles of Behavioral Assessment

INTRODUCTION TO MEASUREMENT AND BEHAVIORAL ASSESSMENT

BEHAVIORAL ASSESSMENT AS A CONCEPTUAL AND METHODOLOGICAL PARADIGM

DATA FROM MULTIPLE SOURCES CAN INCREASE THE VALIDITY OF CLINICAL JUDGMENTS

A CASE EXAMPLE OF BEHAVIORAL ASSESSMENT PRINCIPLES, STRATEGIES, AND METHODS APPLIED TO A FUNCTIONAL ANALYSIS

SUMMARY

Chapter 8: Self-Report Methods in Behavioral Assessment

OVERVIEW OF SELF-REPORT BEHAVIORAL ASSESSMENT METHODS AND STRATEGIES

FUNCTIONAL BEHAVIORAL INTERVIEWS

DESCRIPTION OF THE FUNCTIONAL BEHAVIORAL INTERVIEW

BEHAVIORAL QUESTIONNAIRES

SELF-MONITORING

SUMMARY

Chapter 9: Direct Methods in Behavioral Assessment

OVERVIEW OF DIRECT BEHAVIORAL ASSESSMENT METHODS AND STRATEGIES

OVERVIEW OF THE PRINCIPLES AND STRATEGIES OF BEHAVIORAL OBSERVATION

NATURALISTIC OBSERVATIONS

ANALOG BEHAVIORAL OBSERVATIONS

PSYCHOPHYSIOLOGICAL ASSESSMENTS

SUMMARY

Chapter 10: Identifying Causal Relations in Behavioral Assessment

RATIONAL DERIVATION

CAUSAL QUESTIONNAIRES AND CLIENT’s CAUSAL ATTRIBUTIONS

CAUSAL MARKERS

EXPERIMENTAL MANIPULATION

SUMMARY OF RECOMMENDATIONS FOR APPLICATIONS OF BEHAVIORAL ASSESSMENT IN THE FUNCTIONAL ANALYSIS

Chapter 11: Twenty-Two Steps in Preintervention Behavioral Assessment and the Development of a Functional Analysis

INTRODUCTION

STEP 1: OBTAIN INFORMED CONSENT AND PROMOTE A POSITIVE CLIENT-CLINICIAN RELATIONSHIP

Step 2: Evaluate the Need for Referral and the Safety of the Client

STEP 3: IDENTIFY THE CLIENT’S BEHAVIOR PROBLEMS

STEP 4: SPECIFY THE ATTRIBUTES AND RESPONSE MODES OF THE BEHAVIOR PROBLEMS

STEP 5: SPECIFY THE DIMENSIONS OF THE BEHAVIOR PROBLEMS

STEP 6: ESTIMATE THE RELATIVE IMPORTANCE OF THE CLIENT’S BEHAVIOR PROBLEMS

STEP 7: IDENTIFY THE EFFECTS OF BEHAVIOR PROBLEMS

STEP 8: IDENTIFY THE FORMS OF FUNCTIONAL RELATIONS AMONG BEHAVIOR PROBLEMS

STEP 9: ESTIMATE THE STRENGTH OF FUNCTIONAL RELATIONS AMONG BEHAVIOR PROBLEMS

STEP 10: IDENTIFY THE CAUSAL VARIABLES ASSOCIATED WITH THE CLIENT’S BEHAVIOR PROBLEMS

STEPS 11 AND 12: ESTIMATE THE FORM AND STRENGTH OF RELATIONS BETWEEN CAUSAL VARIABLES AND BEHAVIOR PROBLEMS

STEP 13: ESTIMATE THE MODIFIABILITY OF CAUSAL VARIABLES

STEPS 14 AND 15: ESTIMATE THE FORM AND STRENGTH OF RELATIONS BETWEEN CAUSAL VARIABLES AND IDENTIFY CAUSAL CHAINS

STEP 16: IDENTIFY MODERATOR VARIABLES ASSOCIATED WITH THE CLIENT’S CAUSAL VARIABLES AND BEHAVIOR PROBLEMS

STEP 17: IDENTIFY MEDIATORS OF CAUSAL RELATIONS ASSOCIATED WITH THE CLIENT’S BEHAVIOR PROBLEMS

STEP 18: ESTIMATE THE DIRECTION OF EFFECT OF FUNCTIONAL RELATIONS

STEP 19: IDENTIFY IMPORTANT SOCIAL SYSTEMS VARIABLES

STEP 20: IDENTIFY FUNCTIONAL RESPONSE CLASSES

STEP 21: INCLUDE HYPOTHETICAL CAUSAL VARIABLES, BEHAVIOR PROBLEMS, AND CAUSAL RELATIONS

STEP 22: CONTINUE TO REEVALUATE AND REFINE

SUMMARY

References

Author Index

Subject Index

This book is printed on acid-free paper.

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Library of Congress Cataloging-in-Publication Data:

Haynes, Stephen N.

Behavioral assessment and case formulation / Stephen N. Haynes, William H. O’Brien, Joseph Keawe‘aimoku Kaholokula.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-118-01864-4 (alk. paper); 978-1-118-09976-6 (eMobi); 978-1-118-09977-3 (ePub); 978-1-118-09975-9 (ePDF)

1. Psychodiagnostics. 2. Behavior modification. I. O’Brien, William Hayes. II. Kaholokula, Joseph Keawe‘aimoku. III. Title.

[DNLM: 1. Mental Disorders—diagnosis. 2. Behavior. 3. Mental Disorders—therapy. 4. Personality Assessment. WM 141]

RC473.B43H39 2011

616.89′075—dc22

2011008895

To Megumi

—S. H.

To my parents Patricia Hayes O’Brien and William John O’Brien, who blended heart and science and my brothers, Daniel, Timothy, Michael, and Joseph O’Brien, who taught creative thinking and how to take a punch

—W. H. O.

A Hawaiian proverb states, ‘A‘ohe pau ka ‘ike i ka hālau ho‘okahi (not all knowledge is obtained from one school). To my parents, Lawrence and Beverly Kaholokula, whose schooling set a solid foundation. To friends and family, whose schooling is lifelong.

—J. K. K.

Preface

Clinicians face many challenges in the clinical assessment process. Several questions of particular importance arise: What is the best assessment strategy to use with a particular client? What assessment methods will best capture a client—s unique strengths, limitations, behavior problems, and intervention goals? How can data from multiple sources be integrated in order to yield a valid and clinically useful case formulation? What procedures should be enacted in order to ensure a positive clinician-client relationship and be sensitive to the unique aspects of each client? How should intervention processes and outcomes be monitored?1

Behavioral assessment is a science-based paradigm that guides the clinician as he or she faces these assessment challenges. This book outlines the underlying principles of the behavioral assessment paradigm. It also provides guidelines for the application of behavioral assessment strategies and methods that can strengthen the validity and utility of clinical judgments.

In Chapter 1, we discuss behavioral assessment within the broader contexts of clinical and psychological assessment and measurement. Although we emphasize clinical applications of behavioral assessment, the principles and methods of this paradigm are important elements of measurement in psychopathology, education, organizational psychology, cognitive neuroscience, social psychology, and other areas of inquiry that rely on behavioral data.

We emphasize a science-based approach to clinical assessment. Without a scientific foundation, clinical judgments are more likely to be incomplete, less informative, and/or invalid. As a result, clients are less likely to receive optimal intervention benefits. Throughout the book we draw attention to the importance of (a) the client-clinician relationship; (b) being sensitive to the cultural and other unique aspects of a client; (c) the role of the clinician as a behavioral scientist; (d) using methods that can reduce biases in assessment and clinical judgments; (e) using a constructive and positive orientation in the assessment process; (f) using multiple assessment methods, instruments, contexts, and informants to enhance the validity of clinical judgments; (g) using time-series assessment strategies throughout the assessment process in order to evaluate changes in behavior over time; (h) including observation methods in clinical assessment; (i) using measures with strong psychometric evidence appropriate for the client; (j) using measures that are sensitive to change; (k) specifying the key dimensions of behavior problems beyond those associated with a diagnosis; (l) assessing functional relations associated with client behavior problems and goals; and (m) considering the influence of broader contextual and social systems factors that may be affecting a client.

In Chapter 2 we introduce the functional analysis as a paradigm for clinical case formulation. The functional analysis is a product of behavioral assessment—the integration of important, modifiable, causal variables and causal relations associated with a client—s behavior problems and intervention goals. A clinical case is used to illustrate the applications of behavioral assessment methods and to show how data obtained in the assessment process can be integrated into a functional analysis. Functional Analytic Clinical Case Diagrams (FACCDs), which are causal diagrams of a functional analysis, are also introduced. The functional analysis and FACCD are designed to parsimoniously communicate the functional analysis to others, as an aid in teaching case formulations, and to assist in selecting the most cost-beneficial intervention focus with a client. We also examine assessment contexts that affect the cost-benefits of the functional analysis.

In Chapter 3 we present the functional analysis and the Functional Analytic Clinical Case Diagram in greater detail. We discuss the applications of causal diagrams and describe the elements of the FACCD. Elements of a functional analysis and FACCD include: (a) behavior problems and intervention goals; (b) the relative importance and sequelae of a client—s behavior problems and intervention goals; (c) the type, strength, and direction of effects of their functional interrelations; (d) causal variables associated with behavior problems and intervention goals; (e) the modifiability, strength, and directionality of causal relations; (f) the interrelations, multiple causal paths, and interactions among causal variables; and (g) moderator, mediator, and hypothesized causal variables.

In Chapters 4, 5, and 6 we present the conceptual and empirical foundations of behavioral assessment. In Chapter 4, we note how the strategies of behavioral assessment are guided by research on the unique characteristics of a client—s behavior problems. Most clients present with multiple behavior problems and we consider several causal models that can account for comorbidity. The same behavior problem can also differ in important aspects across clients, in terms of the most important attribute, response mode, or dimension. Further, the characteristics of a behavior problem will often vary across contexts and time. Recognizing the complexity and idiographic nature of behavior problems, behavioral assessment strategies emphasize measurement in multiple settings, with multiple methods, including multiple informants, across multiple times, using sensitive and precise measures, and the integration of idiographic and nomothetic assessment strategies.

In Chapter 5, we review causal models of behavior problems that further guide behavioral assessment strategies and the functional analysis. We first review the key conditions that are required for causal inference: covariation, temporal precedence, the exclusion of alternative explanations, and a logical connection. The mechanism of causal action is highlighted as particularly important because it can point to intervention strategies. We also consider sources of measurement and judgment error in the assessment process and strategies that can be used to minimize them.

In Chapter 6, we discuss causal relations that are particularly relevant for understanding clients— behavior problems. We consider how causal variables can have multiple attributes that differ in their causal effects and how a behavior problem can be affected by multiple causal variables. Further, a causal variable can have direct and indirect effects through different paths and can change across time and settings. The idiographic nature of causal relations is an especially important characteristic of causal models of behavior problems and underlies many of the assessment strategies that we discuss in this book. We discuss types of causal variables and causal relations that are most useful in clinical assessment: contemporaneous causal relations, differences in causal relations across contexts and settings, modifiability of causal variables, and social systems factors.

In Chapter 7, we summarize the principles and strategies of behavioral assessment. The chapter reviews how the conditional nature of behavior problems leads to collecting data from multiple sources; how the dynamic nature of behavior problems leads to time-series assessment; and how the heterogeneous nature of behavior problems leads to an emphasis on using well-specified variables in clinical assessment. Behavioral assessment strategies also emphasize a focus on contemporaneous functional relations, the assessment of clients in their natural environment, the use of idiographic strategies, and a scholarly approach to clinical assessment. Finally, in this chapter we present another case to illustrate these principles and strategies.

Chapters 8 and 9 focus on self-report and direct methods of assessment. In Chapter 8, we discuss the assets and liabilities of functional behavioral interviews, behavioral questionnaires, and self-monitoring. Ecological momentary assessment is highlighted as a particularly promising method of gathering self-report data on clients in their natural environment. In Chapter 9, we review direct methods of assessment, including naturalistic behavioral observation, analog behavioral observation, and psychophysiological assessment.

In Chapter 10, we integrate material from previous chapters and outline how causal relations can be identified and evaluated in clinical assessment. The chapter presents the assets and liabilities of rational derivation, the use of interviews and questionnaires to estimate causal relations, the use of experimental manipulations, and multivariate time-series regression methods. The chapter ends with specific recommendations for behavioral assessment strategies that are science-based and reflect our understanding of the nature of behavior problems and their related causal relations.

Finally, in Chapter 11, we return to the concepts presented in the first seven chapters and present 22 steps that can be used to construct a functional analysis.

Overall, the goal of this book is to provide graduate students, clinical researchers, and clinical supervisors and practitioners in the social sciences with an educational, science-based, practical, and informative resource for conducting behavioral assessments, as well as generating valid and useful functional analyses and clinical judgments. As we emphasize throughout this book, the clinician—s ability to select the best intervention for a client, and the ability to monitor the intervention process and outcomes, depends on the degree to which he or she adheres to science-based assessment principles and strategies and collects valid assessment data that allow for the specification of the client—s behavior problem(s) and related causal variables and relations.

1 We often use the term intervention rather than treatment because many behavioral interventions are more broadly focused than the term treatment implies. For example, behavioral interventions can focus on changing the behavior of psychiatric staff members and teachers, strengthening the supervision and training of service providers, simplifying a home environment, or providing a support group for parents of children with disabilities.