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[Music].greetings everyone and welcome to the.National Board of forensic evaluators.webinar entitled how to use online.assessment measures for mental health.evaluations my name is Erin Norton and.I'm the executive director of NB Fe and.I'll be your presenter today this.webinar is a service that NB Fe provides.to all of our members as well as members.of our partnering organizations such as.the American mental health counselors.Association and several state and local.professional associations for those of.you who aren't familiar with mbf ii.we're a national not-for-profit.organization officially endorsed by the.american mental health counselors.Association it provides quality training.and certification in the specialty area.of forensic monolith evaluation for.licensed mental health professionals we.maintain three specialty credentials.including certified forensic mental.health evaluator or CFM a Qi certified.child custody evaluator and certified.forensic behavioral analyst we also.advocate for all appropriately trained.licensed mental health professionals to.be able to administer interpret.psychological tests for more information.about NB Fe you can visit our website at.mbf a.net.i'm simon also launched a couple polling.questions here so we can get a sense of.who's in the audience and and what.you're really hoping that we focus on.today make sure that we make this very.relevant for you many of you who have.attended our webinars before know how.these polling questions work but you.should see on your screen right now your.first polling question please select all.that apply to you so you can select more.than one option if it fits we're.interested in your professional identity.so you can choose a if you are a.counselor including clinical mental.health counselors be if you are a.psychologist see if you are a social.worker d if you're a psychiatrist or.psychiatric nurse practitioner and then.finally e if you're a marriage and.family therapist so we will give you a.moment to choose any of these.professional identities that apply to.you.83% of you are counsellors 17% said they.are social workers 10% identified as.psychologist 10% as marriage and family.therapists and 0% psychiatric nurse.practitioners were psychiatrists okay so.primarily counselors today the second.and final polling question is how much.experience have you had with dsm-5.online assessment measures you can only.select one option a I don't know.anything about them B I've heard of them.but I haven't used them see I've used.them a little D I've used them.moderately or e I've used them.extensively go ahead and close this.polling question out launch our results.38% said you've used them a little 34.percent said I've heard of them but I.haven't used them 14 percent said I.don't know anything about them 10% said.I've used them moderately and 3% have.used them extensively.okay so there's at least a little bit of.knowledge and experience with using.these tools for most of you all right so.then we will launch right into our.slides here and get going because we.have limited time today to be able to.explore these tools so first there's.information about me in the slide in.case you are looking for information and.there's also an email address you can.see in the lower left hand corner there.Erin at NBF annette so in the event that.you have follow-up questions that you.didn't ask or didn't think to ask during.the presentation feel free to send me an.email at that email address sometimes it.takes me a couple days to respond but.i'll be happy to answer some follow-up.questions for our attendees today.handouts i mentioned how you can access.the slides for today by clicking on the.handouts link and your GoToWebinar.control panel but in addition you can.use this address just type app box comm.slash v as in victor slash online.assessment measures and then you will.not only be able to get the PDF for the.slides but what I also have in there is.a little bit of information about the.research and background.these online assessment measures from a.journal article and then in addition I.have a folder that actually contains all.of the level 1 and level 2 cross-cutting.symptom measures and it has two versions.one version is the entire file which.includes the instructions for the.practitioner but the other version and I.think I labeled that folder handouts is.are ones that you can send or give to.clients because they do not have the.scoring instructions it's just the part.that the client responds to but keep in.mind you can access all of those.measures online and that's what I'll be.showing you today at the APA z-- dsm-5.website but additionally in this handout.folder I have some information I got.from the World Health Organization on.their disability assessment schedule.which is one of the measures that we'll.look at today and include some Excel.spreadsheets that you can use to type in.client responses to calculate scores.more efficiently and quickly than the.handwritten version so all of those are.you'll find in that folder and all of.those are resources that you can find.online for free just by a simple google.search.so why are we covering this topic today.the intention is that if you're in any.of these groups that you'd be able to.benefit students in various mental.health professions and interns who are.pursuing licensure are often lacks some.confidence in their diagnostic abilities.and that makes a lot of sense they're.early on in their career and these.online assessment measures I think.creates some structure and some guidance.for students and interns and by using.them at first they eventually start to.get the feel for the diagnostic process.and they accidentally memorize things.even so that they will be relying less.on tools at different points and they're.depending on what they're doing if you.are a counselor educator or a clinical.supervisor therefore you're also going.to be interested because you could be.using these resources to help your.students understand the diagnostic.process or your interns or the.counselors that you supervise and help.them.professional development if you're a.therapist these tools will be great not.only for assessment and a clinical.environment but also for measuring.progress as you continue to work with a.client if you're an administrative.supervisor you're probably going to be.interested in these tools because they.are ways of measuring client outcome and.because third party payers love it when.you can provide some somewhat more.objective or quantifiable means of.measuring the not only client.symptomatology but also quiet progress.and then finally forensic evaluators you.although these tools have some.limitations in the forensic arena that.we'll be discussing later on you might.be very interested in these tools.because it may help you help guide your.clinical interview and they're great.supplements too some of the other tests.that you'll be using but additionally.some of you attending today might be.folks who are just beginning your.forensic training and your forensic.certification process so for example if.you've applied for the certified.forensic mental health evaluator.credential you know that you'll have to.be creating a sample report that you'll.defend in the oral examination and in.that sample report there's a section for.testing but we often get the question.what if I don't yet have training on.testing or I don't I'm not level C.certified for tests or I'm not competent.to to conduct certain types of tests or.I don't have access to tests because I'm.early on in my career and I haven't made.the financial investment and starter.kits yet so what we do is we try to put.those applicants and candidates in touch.with these free online assessment.measures which are easier to train on.and easier to use for several reasons.that we'll discuss later on but they can.very quickly pick up on and that they.can all access at no cost to them and.then use those for their sample reports.although in the real forensic arena you.will want to supplement these tests with.other types of more sophisticated tests.that we'll get to later all right so let.me before we go any further just check.in and see if we have some questions too.to address looks like one person is.saying that.there's a very poor connection my hope.is that that's strictly for that one.person hopefully everyone else is.getting a fine connection I haven't seen.any other concerns yet so for that.individual I would it could just be your.internet connection and you may want to.look at maybe if there's a way for you.to connect through the wall or through a.direct line it looks like everyone else.is saying that things are pretty clear.so I think that's an individual problem.unfortunately but the good news is we'll.also be recording this so there will be.a way for you to get any information.that you might have missed from a poor.connection and it looks like there are.no other questions or comments right now.so we'll go right back into the slides.so first let me talk about the reason.the justification for these online.assessment measures there are a lot of.justifications for them but especially.for the cross-cutting symptom measures.one of the justifications is that if you.were to go to your primary care.physician and get an annual exam your.doctor isn't going to ask you every.question about every symptom about every.disorder in existence there's no way.they would ever be able to do that you'd.be there for days and they certainly.wouldn't have the expertise to even.diagnose every condition under the Sun.and standard where your primary care.physician does is they ask a small.number of questions and they check out a.small number of things maybe physically.and only if they get a hit a positive on.one of those screening questions do they.then open up another layer an additional.layer of questions to try and formulate.a more specific diagnosis well the.American Psychiatric Association.believed that mental health.professionals should be doing something.very similar that we should start with a.small number of screening questions and.then if we get a hit on one of those.screening questions we know to move on.to a second layer of questioning to.start refining our diagnosis so I'm.going to show you for example all the.level two cross-cutting symptom measures.you would never want to give every.client all of the.measures they'd be completing forms all.day you would only give them level two.measures if in the screening questions.on level one you get a hit so it is very.a very individualized process in that.sense all right so the online assessment.measures they all come from the dsm-5.very specifically section 3 of the dsm-5.which is entitled emerging measures and.models that's the section where they.will put in not only measures that we're.going to be talking about today but they.also add conditions that are being.studied and debated and considered for.adoption and future editions of the DSM.so sometimes disorders make it from.section 3 to section 2 which is the.official the section of the DSM that has.all of the official identified disorders.the ones that the eight the DSM.committees have agreed upon so in.Section three these are the different.measures that you'll see first you'll.see cross-cutting symptom measures for.diagnosing for identifying symptoms that.are part of diagnosis and there are two.levels of cross-cutting symptom measures.then you'll see severity measures that.help us to identify how severe.somebody's disorder might be on a.spectrum third you'll see disability.measures and these will be your measures.to help determine how does the person's.symptoms affect their ability to.function socially and occupationally and.relationally and in terms of self-care.because that's part of diagnosis also.that we often miss sometimes in the that.we focus so much on symptoms that we.don't focus enough on functioning.symptoms aren't enough for a diagnosis.you have to be able to demonstrate that.the person symptoms are causing.clinically significant impairment or.distress and that's where these.disability measures can come in handy.but there are also some new personality.inventories based on a new hybrid.multi-dimensional model of personality.disorder diagnosis that hasn't yet been.official.adopted but in all probability will be.adopted into the next DSM they actually.tried to adopt it in the dsm-5 but.because of controversy at the last.minute they decided to just Park it in.section 3 for now and let people kind of.ease their way into it over the next.several years but the writing's on the.wall with these new personality disorder.diagnostic processes I believe and then.finally you will see two measures that.deal with early development and home.background one of them is called the.early development at home background.form which is for children and then the.second is the cultural formulation.interview which i think is very.interesting and very helpful and that.tool will help you to rule to help help.you identify whether somebody's symptoms.and symptom presentations are culturally.appropriate or not because in some cases.you won't even be diagnosing if they're.culturally appropriate and accepted.reactions so let's start with our.cross-cutting.symptom measures the very first type of.measure that you'll see these like I.said are modeled on general medicines.review of symptoms and they serve as an.approach for reviewing critical.psychopathological domains level 1.screens for 13 different clinical.domains for adults or 12 for minors and.so they're like on the adult version for.example there are 26 items that are.lumped into 13 categories and then if.you get a hit and one of those 13.domains you move on to level 2 where you.do a more in-depth assessment of just.the domains that you got a hit on from.level 1 so let's pull out of the slides.for just a moment and actually show you.what this looks like online so what I've.done here is that you'll see on my.screen as I went to dsm-5 org it doesn't.look like that because you automatically.get redirected to a different URL but if.you type in dsm-5 work then this is.where you end up DSM the number 5 org.and if you scroll down here you will see.on the right hand side online assessment.measures so when you click on online.assessment measures you will be.redirected to this page and here we.start off.with our level one cross-cutting symptom.measures notice that there are three.versions for the level one measure there.is the adult version which is also.available in the dsm-5 then there is a.parent slash Guardian rated version four.for children aged 6 to 17 this is one.that the parents will complete on the.behalf of or about a child who's a.client and then finally there is a.measure for adolescents extra for ages.11 to 17 to complete for themselves and.what I will often do when I'm working.with minors as have both the parents do.the parent version for their child and.have the child if they are not a lesson.to do the measure for themselves and.then also compare the results with each.other so let's to keep things simple.let's just pick the adult version here.for a moment we'll click on it and then.what you can see is a PDF has.automatically been downloaded in my.browser so I'll open that PDF and page.one of the PDF is always your disclaimer.and then it's got information about the.measure itself and then here is your.actual dsm-5 self rated level one.cross-cutting symptom measure the adult.version this is the only form that you.will ever hand to a client if you even.hand it to them at all it's a one-page.form that has 23 items in 13 different.categories then page 3 is instructions.for the clinician so you never want to.give this to a client now what I do is I.when I have therapy clients I actually.all clients pretty much I have them fill.out this form in the lobby as part of.their intake packet before they even see.me it saves me a lot of time and.especially when doing therapy with.clients I really like to minimize the.interrogation that can happen in the.first appointment when you're asking a.million questions to formulate a.diagnosis I like to guide my questions.to and have them have a screening.process already in place.I can also focus on what I think is most.important in the therapeutic rat.interaction which is to establish.rapport and a therapeutic relationship.in addition to formulating an assessment.focusing more on what's relevant to the.client and focusing less on what's not.relevant to them so I'll usually have.them do this in the lobby for the.measure one a level one if you have an.EHR system or a client portal you may be.able to share this measure with them.before they ever come in so they can.complete it before they come in for.their appointment I've noticed many it's.extremely common to see that both.primary care physicians and other.medical specialists well have you.complete forms like this before they.even talk to you and that it makes a lot.of sense I think for us to do the same.so you'll see this is a very here and.now cross-sectional questionnaire.because they're asking you to ID to.think only about the past two weeks when.you're completing this form so it says.during the past two weeks how much or.how often have you been bothered by the.following problems and then you have.your 23 questions and then you have a.spectrum of answer possibilities up here.and the upper right ranging from none to.slight to mild to moderate to severe and.the client will circle whatever number.best fits for them for that question.when considering the past two weeks so.the first two questions and domain.number one are little interest or.pleasure in doing things and feeling.down depressed or hopeless so anybody.want to guess by typing into their.questions box what family of disorders.we are screening for with these two.questions go ahead and type your.response into the questions box here you.guys are quiet no one has submitted an.answer yet it doesn't look like okay.there we go finally people are chiming.in so sherry and Dennis and Kirk have.all said depression and you are.absolutely right these first two.questions are obviously screening for.depressive disorders now the idea is.this if you look at the diagnostic.criteria for depressive disorders.if the quiet circled zero for both of.these and assuming that they were.insightful and honest in their.self-report then you can automatically.rule out depressive disorders so no need.to be asking a bunch of questions about.depression during the clinical interview.I know that there's a couple ifs built.into that but you would only be.considering depression if you got a one.or higher in this category our question.number three feeling more irritated.growl chi or angry than usual is domain.number two now this one's not actually a.disorder family it's just literally.anger I think it is it's just getting a.sense of are they presenting with a lot.of anger or not but domain number three.sleeping less than usual but still.having a lot of energy and the second.question for that domain is starting.lots more projects than usual we're.doing more risky things than usual.anybody want to guess by typing into.their questions box exactly you guys are.already guessing so yes we're we're.screening for mania here for the.possibility of bipolar and bipolar.related disorders so everyone is on the.button and responding to that question.next section section four has three.questions feeling nervous anxious.frightened worried or on edge feeling.panic or being frightened avoiding.situations that make you anxious you all.could probably guess I'm sure that these.are screening for anxiety disorder.questions these are this is looking for.the possibility of one or more anxiety.disorders section 5 has two questions 9.and 10 this might be a little bit harder.for some folks unexplained aches and.pains examples head back joints abdomen.and legs and the second is feeling that.your illnesses are not being taken.seriously enough anyone want to guess.what disorders we're talking about here.so far we've got a few responses.everyone has says somatic one person.said malingering so yes these are.somatic symptom disorder screening.questions numbers 9 and 10 question.number 11 thoughts of actually hurting.yourself as a suicidality screening.question then we go to section 7 or.domain 7 to questions.doing things that other people couldn't.hear such as voices even when no one was.around and feeling that someone else.could hear her thoughts or that you.could hear what another person was.thinking and already you guys are typing.in psychosis psychotic disorders you're.absolutely right the 14th question.category number 8 problems with sleep.that affected your sleep quality overall.anybody want to guess what we're.screening for pink dsm-5 section 2 and.all the different chapters of disorders.in section 2 sleep disorders there we go.some of you had some other guesses but.the right answer is sleep disorders and.then section domain number 10.item 1617 unpleasant thoughts urges or.images that repeatedly enter your mind.and feeling driven to perform certain.behaviors or mental acts over and over.again and you guys are already typing in.OCD that is correct these are your OCD.and OCD related or se related disorders.then we go to oh I skipped one.I skipped question number 15 problems.with memory learning new information.orthe location finding your way home so.for question 15 there think Section 2.DSM and all the different chapters or.that our families of disorders which.family disorders do you think we're.screening for with question number 15 no.guesses yet all right.we Krista you've got it right it is.cognitive Narottam disorders very.specifically that we are screening for.with that question number 18 in Section.11 feeling detached or distant from.yourself your body or physical.surroundings or your memories.we have dissociative disorders that.people are guessing absolutely right and.then we go to this one might be hard for.some people to answer question us domain.number 12 questions 19 and 20.not knowing who you really are what you.want out of life not feeling close to.other people or enjoying your.relationships with them what are we.screening for with these two questions.search we got lots of different answers.so people are guessing a lot of things.some people said adjustment disorder.some said PTSD some said personality.functioning and some said personality.disorders personality disorders are.indeed what we're screening for with.these two questions and then finally our.domain number 13 should be pretty.obvious questions 21 through 23 have to.do with alcohol consumption tobacco use.and the use of any illicit drugs or non.prescribed medications and that's where.we're screening for substance use and.addictive well substance use disorders.now one thing you may already be.noticing hopefully you're noticing is.that there are other disorders that.aren't included in this measure at all.so for example you don't see anything.here that deals with gambling the you.know a gambling disorder for example so.there are some disorders that are not.captured and fortunately you don't see.any ADHD screening questions either so.there's no neurodevelopmental disorders.that we're screening for on this so that.is one limitation to the cross-cutting.symptom measures is it only covers 13.domains that are commonly encountered in.our treatment environments but there are.some disorders that are not included so.we want to look for other measures for.those disorders and I will be showing.you those other disorders those other.measures later on that we can find from.other resources so anyway if we move on.to page 3 for the level 1 we see that we.have our instructions for clinicians and.they tell you how to score it interpret.and they tell you with each of these.domains what scores would indicate that.you should move on to a level 2 measure.now notice that there are no level two.measures for some of these like suicidal.ideations psychosis and memory there are.some severity measures in on the website.for things like seok psychosis but not a.level two so you may be looking for a.different measure or just doing your.standard diagnostic interview to assess.further in those categories so let's.move on then to level two let's imagine.that this client had a hit and the.domain for OC or obsessive-compulsive.related disorders if that were the case.and they were an adult then we would go.to level two repetitive thoughts and.behaviors as instructed by the by page.three of the level one measure and we.would click this measure which is.actually adapted from the Florida.obsessive-compulsive inventory severity.scale so we'll download that measure and.again page one is your disclaimer and.your general information about that.particular test and it's just a one-page.questionnaire for the client followed by.your clinical instructions for how to.score and interpret this page so.something I want to point out here is.you have options for how you can move on.to a level two measure.I sometimes if we didn't have time to.you know we had a very busy initial.appointment we had a lot to discuss I.might give him the level two at the end.of the appointment they can do to the.lobby oh I'm meeting with my next client.in some cases when I'm doing an.extensive evaluation.I might actually what I wouldn't do for.a forensic evaluation has ever give.somebody a test to take home or have.them do it on their own because you.never can know for sure if they're the.ones doing it and you also can't control.the testing environment to make sure.it's an appropriate environment but some.what I do a lot of times is I'll.actually do the level two measure in the.room with the client because I have them.all on my iPad so I'll just pull it up.and I'll start writing and circling.things and asking them questions they.don't know that I'm administering a.questionnaire necessarily it looks just.like part of the clinical interview so.here you will ask some these questions.on average how much time is.keep I'd buy these thoughts or behaviors.each day and so on and they'll mark.their responses or if you're doing it.verbally you'll give them maybe some.written instructions for which number to.give you in response and then they can.call it a number every time you ask a.question it depends on how you want to.use your level to measure I tend to.prefer to have them do it in writing.though separate from the clinical.interview and use it as an additional.data point that supplements a clinical.interview so if you it gave them the.level to measure and let's say that they.came up with a higher score that was.maybe oh let's go with a score an.average score of two then we would say.that these are pretty severe symptoms so.the level to measure helps you to to.really formulate your diagnosis by.looking at specific symptoms or.probability of having a disorder now.let's say that you have a level that you.want to go beyond the level two and you.want to like I guess a good example.would be depression the level to.depression measure doesn't really have.specific symptoms DSM symptoms of a.depressive disorder but they what it is.is a probability conclusion if is if a.person answers these questions a certain.way and there's a high probability that.they have a diagnosable depressive.disorder what I then would do is I'd.move on to our next category the.disorder specific severity measure so.let's go back to our PowerPoint here and.I'll show you those but before we do.that we have a question and I I'm sorry.I could be pronouncing your name wrong I.think it's night Ian more needy on the.question is I miss some info due to.connections but how do you get these.screenings you get a dsm-5 org that's.DSM the number five org and then you.click on online assessment measures on.the right-hand side so it's dsm-5 org.and then click online assessment.measures all right so back to our slides.we covered our cross-cutting symptom.measures now we go on to our disk.our disorder severity measures these are.very disorder specific and they help you.to determine the severity of the.symptoms so let's assume that you have.done your level one and level two and.your clinical interview and you've.already decided this client definitely.has a depressive disorder but now and.let's say more specifically a major.depressive disorder but you now really.want to look at severity but how severe.is their depressive episode here's where.this measure will come in very handy the.disorder severity measure tool it also.can be helpful when you have a client.who's just shy of meeting the diagnostic.criteria for a disorder and you're.considering another specified or an.unspecified to diagnosis so for example.let's say a client came in and they said.that they were feeling significantly sad.down or depressed more often than not.and that they were having a difficult.time concentrating that they were losing.interest or pleasure and things they.normally enjoy and that they were having.some passive suicidal ideation they've.been thinking a lot about death and.dying they find it very hard to get out.of bed they spend more hours in bed than.they ever did before but they feel way.less rested than before and they're.fatigued during the daytime no matter.how much sleep they've had and they're.also eating a lot less than usual.because they lack an appetite well that.sounds like a major depressive episode.right but what if the client told you.and this has been going on for 12 days.well some of you know that for it to be.a major depressive episode it would have.to be 14 days 2 weeks of those symptoms.to call it a major depressive episode so.they've come into your office and sadly.they're well depending how you look at.it they're two days shy of meeting the.diagnostic criteria for major depressive.disorder well what I would do in a case.like that if I decided but they're.experiencing clinically significant.impairment or distress I don't see this.going away in the next two days and.they're here now and they need help now.then I would probably diagnose them with.a depressive disorder , other specified.comma does not meet full duration.criteria which is my way of denoting why.I'm not diagnosing them with major.depressive disorder quite yet but I'm.still gonna call it a depressive.disorder well let's say the insurance.company they never do this for me but.let's say then an insurance company or a.third party payer said well we want more.information about this other specified.diagnosis then if I had done a disorder.severity measure I could show look there.they have a pretty severe symptom.presentation for depression regardless.of whether they're just two days shy of.meeting the technical diagnostic.criteria and that would be one way to.sort of back up that they still are.disordered and they still need the.intervention that I'm providing so let.me show you an example of one of these.measures let's click on disorder.specific severity measures let's look at.depression and notice how they're using.a variation of the phq-9 many of you.know this tool because many of you have.already used it before it's a one-page.questionnaire and if you look at these.items these are basically the symptoms.the DSM symptoms of a depressive.disorder and the client can circle based.on the past seven days only so it's just.a one day snapshot whether they didn't.experience these symptoms at all or they.did for several days more than half the.days are nearly every day for the past.week and so let's say that client who.was on day number 12 of their major.depressive episode issue symptoms but.they've got a lot of severe you know.they've been troubled by these things.nearly every day and Alaia have a lot of.symptoms that helps to justify that.you're still diagnosing them and then.here is your score range that tells you.is it mild moderate moderately severe or.severe depression.now you also could read Minister this.tool periodically when you work with the.client showing that their score is.reducing with time and therefore they're.making progress clinically and that can.justify continued care but let's say.they still have symptoms and that can.justify that they're continuing to work.with you so having covered our severity.measures let's move on to our disability.measures.this is one that counselors and my.experience are a lot less knowledgeable.about so for those of you trained on the.dsm-4 and dare we say that some of you.are also maybe trained on the dsm 3 or.maybe even the DSM - you know who you.are because you've been around that long.in the field and we used to have a gap.score a global assessment of functioning.score and it was this number that we.would try to use to quantify how severe.a client is and there were many many.problems with the GAF school I was the.way I was trained to do a GAF score was.a my first job I oh it was only a.bachelor's level counselor working in a.treatment center and I was doing my.first psychosocial update and at the end.it asked for a gap score and I asked my.clinical supervisor how do I do a gap.score and I kid you not this is what.they told me they said well go to their.chart and see what the psychiatrist gave.them as a gap score when they came in.then increase that number to show that.they've made progress but don't let it.hit this high which I think was like 70.or something because if it's that high.they'll say that they're doing too good.to stay in this residential program.they're not done with their treatment.yet ok well that is a complete misuse of.the GAF system that basically was a game.that people were playing just to justify.what they were already doing not an.assessment measure so there was very.poor inter-rater reliability with GAF.scores - people could meet with a client.come up with dramatically different.numbers the number was being abused it.was too dichotomous so with the dsm-5.they said we're scrapping it we're not.replacing it with anything but we are.recommending that client counselors now.consider an additional measure called.the hood as 2.0 as the World Health.Organization disability assessment.schedule and this is your tool that is.used to assess a client's ability to.perform activities in six different.areas of living so here we're getting a.sense of how does the person's symptoms.affect their ability to function in the.world.socially occupational.and in terms of relationships and.self-care now let me pause here for a.moment because I do see I see some.comments there's some laughter and then.that's exactly what I was told back in.the day all right so you guys know how.we got trained poorly on how to do the.gaffe score back in the day all right so.let's so these are your six domains by.the way they are understanding and.communicating getting around self-care.getting along with people life.activities and participation in society.so let's take a look at this measure and.see what it looks like.we have disability measures right here.we click next to it you've got two.versions there's a version and that is.36 items that can be self administered.by the client and then there is a proxy.administer that means that someone else.who knows the client very well as.answering based on their observations as.a side note when I'm doing forensic.evaluations that might relate to.disability like well this is kind of a.clinical slash forensic eval but I did.an emotional support animal letter.evaluation last week and so I had the.client do the who'd asks for himself but.I had a family member who knows him well.do the who des from what they see and.the client and then I compared the.answers to see if I see some degree of.consistency in terms of the way that the.clients symptoms are reportedly.interfering with their ability to.function so it's kind of nice to have.both of those available now if you go.online to the World Health.Organization's website and you - just.google who - World Health Organization.then you'll see that they have other.versions available that are shorter.versions and that sort of thing but.these are the versions that the APA.adopted into the dsm-5 and they're the.versions I use you'll also see that.although you get let's just download one.of them here actually let me we have our.page of disclaimer and then basic.information and this one's actually a.two page client questionnaire so the.client will get two pages and they are.asked to think about the.thirty days and to think about how much.think about any diseases or illnesses or.other health problems that they have and.then circle one answer per item for how.those disorders are affecting their.ability to function in the past 30 days.how much difficulty they've had with.these functions so we've got.understanding communicating we've got.various items there so we basically have.our six different domains and they're.gonna circle on a spectrum how much they.believe that they've had difficulty with.these things in the past 30 days and.then you have your counsellor.instructions for scoring now what I like.again is to use the Excel spreadsheets.which I have you'll see that I have them.in that box folder that I gave you a.link to because then it automatically.calculates percentile rankings for me.based on the clients responses so that.would be a way for you now when you.diagnose using the dsm-5 you have the.option of including who has scores in.your diagnosis a lot of people don't.know that but and you know how you used.to have your your five axes and then.you'd have your gap score at the bottom.of your diagnosis well you can do the.same thing with the who guess in with.the dsm-5 diagnosis you can throw that.into your diagnosis your who test score.if you want to it is optional but if.you're really thorough then you can add.that alright so let us move on now to.our next category which is our.personality measures this gets a little.bit complicated and I'm not going to go.into the new personality disorder.diagnostic system because that would.take a long time and I'm even a little.unclear about some things with it but.I'll give you the basic gist here with.the new model that is being used.worldwide and that I'm sure will.probably end up in the next edition of.the DSM like I said they were so close.to putting in the dsm-5 they intended to.put in the dsm-5 actually originally so.a diagnosis of person itis or is is.based on two determinations with this.new model.number one we assess the level of.impairment in personality function in.two different domains self which.includes identity and self-direction an.interpersonal which includes empathy and.intimacy notice how the two items that.screened for personality disorders in.the DSM cross-cutting symptom measure.level one questionnaire dealt with these.two domains so if we get hit on one of.those two we know to start assessing for.personality disorders now the second.piece to a diagnosis of a person eye.disorder using the new model would be an.evaluation of pathological personality.traits so they have identified five.trait domains that are disorder.personality that exist universally with.human beings cross-culturally and within.and those five domains are composed of.25 trait facets I think it's five facets.per trait domain for a total of 25 trait.facets we can't get into all that today.all I am going to tell you today is that.there is a new handy dandy measure that.you will find under personality.assessment inventories our personality.inventories we've got a few versions.we've got a brief version that just.focuses on the five domains but not the.25 facets and then we've got what is.probably far more useful is the more.extensive version which is the this one.I think for adults and we've got an.informant so like right now I'm doing an.evaluation with with a woman it was very.defensive and she kind of minimizes it.under reports but other people in her.life and a physician and others think.that she has a personality disorder so.if you want to guess she did the self.rating form and was basically like I.have no problems with anything and then.when others filled this out they said oh.yes she has problems with things and.there's kind of a concurrence among.other people on what those problems are.even though she's denying them all so.this informant form can be helpful if he.were going to use this measure as a.supplement to other measures and say a.forensic.raishin but at any rate let's pull up.the form and let's assume that you have.a client like a lot of therapy clients.are who is pretty motivated to be.honestly disclosing to you and that they.have enough insight that they could.probably pretty accurately respond to.things look at how long this is.it's got goodness 220 items that fit.into those 25 facets which fit into.those five domains and then you have all.the facets here like eccentricity.emotional lability grandiosity and so.forth and then you have your trait.domains the five domains of negative.affect attachment antagonism.disinhibition and psychoticism and in.the new model you would create.personality disorder diagnosis du jour.based on various combinations of these.different of impairments and different.facets and domains and then here your.instructions for the clinician like you.see on all the other measures so for.time purposes that's all I can really.tell you about personally personality.inventories for right now I think.because that's something we all just.have to learn but let's move on in the.next category of online assessment.measures we've got early development and.home background so this includes the.early development in-home background.form which is when you are evaluating.children only and it has three areas of.focus early development early.communication and home environment these.first two are I think of them as.screening for possible developmental.disorders and developmental delays and.then this helps us to understand the.context the social context of the child.but then we have this other really neat.tool that I like a lot called the.cultural formulation interview I like it.for many reasons one is it really helps.us to be more competent with our.multicultural assessment because no one.I mean you could try and study every.culture in the world and you will never.be able to truly know.all of the cultural norms and all of the.exceptions and variations of those.cultural norms in any culture even no.matter how hard you try but what you can.do is explore with the client their.perception of how their culture and.their background factors in to their.presenting concerns and that's what this.tool really helps you to do because.remember when you're diagnosing for many.disorders you also factor in but is this.kind of normal in the context of a.person's culture even though it may not.seem normal here in this particular.culture and that's at least something to.consider and it's also important to.consider when you think about your.treatment interventions being aware and.mindful of the clients culture and how.that could impact their treatment so.let's take a look at these measures real.quickly here here we go early.development and home background our.final category for children ages 6 to 17.we have the parent or guardian.background form and then we have the.form that the clinician can use for.their own ratings and what's going on.with the child based on observations and.interview and if we just open one of.those up real quick it's a one-page.questionnaire this is the one that.parents fill out and here's your.categories early development so are they.born prematurely and those sorts of.things early communication and then.finally learning about the home.environment understanding the context.within the household then we have our.cultural formulation interview which.again I think is really neat and it's.basically just like a structured.interview of specific questions that you.can ask a person during the interview.you can ask things about what brings you.here today and then when you get the.information and you can ask people often.understand their problems in their own.way which may be similar to or different.from how doctors describe the problem.how would you describe your problem if.they're very symptom e you can ask them.for their two.you can ask about how their family.friends or others in their community.describe the problem and how you how the.client would describe the problem to.them you can ask the client what really.troubles you about this problem and then.you guys on about their perception of.causes why do you think this is.happening to you.you might have a client for example who.is particularly religious and they.conceptualize the problem as being a.form of spiritual warfare well that's.really good to know about when you're.working with a client what do others in.your family or friends or others in your.community think is causing your problem.so what do others think is the cause.are there kinds of support that make the.problem better or worse so maybe they.reach out to in their community or their.family and are there stressors in their.community that make the problem worse.and and so on I won't go through all of.these items but you get the idea it's.lots of questions to help you - it's.more of a qualitative measure just like.the early development form that we just.brought up our these are more.qualitative measures to help you.understand the individual and their.context so those are all of the online.assessment measures in a nutshell the.brief version so I want to move on to.some other tools before I do that do we.have any questions on the online.assessment measures oh wow we only have.7 minutes left so no well how about this.instead of you can type in your question.if you want to but I'm going to go ahead.and just really quickly move on to the.other resources so like we said earlier.these online assessment measures only.cover 13 categories of disorders and.there are others so there are additional.tools available to you for example Samsa.the substance abuse and mental health.services administration under the US.Department Health and Human Services has.a listing of online of screening.inventories at their government website.and they've got categories depression.drug and alcohol bipolar suicide risk.anxiety and trauma I have found the.trauma screening tools to be kind of.neat and helpful look at our dsm-5.online assessment measures.been talking about it all right here.healthy living questionnaire there's.just a lot of really neat tools on this.site so that's certainly one to be aware.of if you're looking for some commonly.used free tools and Scott D Miller has.as outcome rating scale and session.rating scale which are great simple.measures that really help to collect.client feedback and get a sense of what.might help the client to improve and.what the client thinks about the.therapist and the treatment being.provided and if you would like those.tools for free you can visit Scott D.Miller you have to go to the measures.licensing and you have to register to.get the license to use the tools they.are wonderful tools and then Jayco has a.listing of like a gazillion different.instruments they don't have links to.those instruments necessarily but they.have information about them so that you.could google them and find other find.out if they're available for free online.or not now there are some ethical.considerations and limitations using the.yarmulke code of ethics as an example we.need to choose reliable Vout and.appropriate measures there's a lot of.research on the reliability and validity.of the measures that we've covered today.and the ones that we didn't cover so I.didn't have time to really go into great.detail about those items but you can.look that information up later and I.have some in the folder you need to be.able to discuss limitations of.generalizability of the results with.clients and the imperfections of these.tools you have to be able to justify the.logic of the tools you choose avoid the.outdated and obsolete ones that's why I.kind of like these measures because.they're updated you have to be able to.provide the client with information.about the rationale and how much time it.takes to complete them and how you're.going to use the data provide an.appropriate testing environment and you.base your diagnosis on multiple sources.of data whenever possible and ensure.that you are competent and tested.administration and interpretation some.of the limitations for those measures.we've talked about are that none of them.have validity scales built in so all of.these tools rely on the client to be.accurate and insightful.and open and honest about what's going.on with them and many of you know that's.not always the case so let's say you're.doing a forensic evaluation and clients.may have there might be very strong.threats to validity I would never use.these tools only I would use tools that.have validity skills built in like the.personality assessment inventory where.the sirs to you from rolling Goering or.whatever and then these tools I would.use more to guide my clinical interview.with the client or supplement to those.tools but again for those of you who are.pursuing certification if you do not yet.have access and competency in the more.sophisticated test then these are.appropriate measures to put in your.sample report while you're pursuing.certification and then you can do.additional training on other appropriate.tests to use and you know when you give.clients big giant stacks of forums and.stuff and sometimes that can be.overwhelming and irritating but I think.this system helps to minimize that.because you're only using what's.appropriate given the screening the.initial screening so that is it for.these slides and now we can cover.questions so I think it's medium has.asked are the measures are these.measures in Spanish that is a great.question and I do not know the answer to.that I didn't see Spanish versions on.the dsm-5 website but maybe sending a.message to the website folks a contact.us question they might be able to answer.if there are Spanish versions and I know.that for some of these tools there are.Spanish versions like for example on the.samsu screen tools website one of the.tests on there for substance use I think.is the audit and I know that's available.in Spanish I've seen it in Spanish but.you might have to do some Google.searches and things to try and find out.if it's available in Spanish and if so.where you can get it from the who that's.2.0 is available multiple languages.because it was created by an.international organization I would be.shocked if they didn't have a who dass.2.0 Spanish version I just don't know.where to get those.I wish I could tell you more about that.next question.is in terms of on my measure okay gotcha.so I think that's a follow-up to neons.question Angie says thank you well done.really enjoyed the session.I appreciate that if there are no other.questions right now then I need to.quickly give you just a couple last.pieces of information here and remember.you can send me follow-up questions if.there's something that you didn't get to.ask today or you think of something.later on but remember to complete that.webinar evaluation form which will.appear on your screen after I'm done.talking and if you miss it there'll be a.second opportunity and a follow-up email.that you'll get in about an hour and our.next webinar is entitled how to conduct.a comprehensive mental status.examination which is on Friday March 1st.for 3 to 4 p.m. Eastern time with dr..Norman Hoffman and you can visit our.website mbf v-net that is one of the.most missed messed up sections and.reports that we've seen is the Mental.Status exam section many classrooms are.not being appropriately trained for the.metal status exam so I'd strongly.encourage you to check out that webinar.with dr. Hoffman so that you can learn.how to do a really good Mental Status.exam now needy on or Annette has asked.maybe have the PowerPoint so again you.can go to your GoToWebinar control panel.click on the triangle symbol next to.handouts and download the PowerPoint or.you can use the link that I gave you.earlier to download it and some.additional some additional items here it.is the link is app box comm /v / online.assessment measures that should also.answer.neons question about the slides being.available and Lisa says mental status.workshop not online I don't really know.what you're saying Lisa but I will show.you all how to get to that that training.online you get an MBA Fein it and then.you go to training notice it.have three training categories there's a.live training of its webinars on demand.and home studies this will be a live.training both later converted probably.to an on-demand and then if you scroll.down here it is how to conduct a.comprehensive mental status examination.so you would click on that to get more.information and to register I think that.should take care of your questions so I.wish you all a wonderful weekend it's.been great spending time with you today.I hope this was a little helpful.lightning-round on online assessment.measures and we'll be posting the.recording and we will see you next time.have a good one.[Music].you.

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