Thursday, November 29, 2012
I believe the ability to accurately assess older clients has, and will continue to become an important issue in counseling. As the Baby Boomer generation reaches retirement and older age, this population will need assessments that may be somewhat different than the typical measures used for evaluating older individuals from previous generations. People live longer and the needs of the current aging population has demands not common in the aging population of 50, or even 20 years ago. As Whiston (2009) mentioned, 60 is the new 40, and this group has expectations for their future (Mellor & Rehr, eds., 2005). The knowledge used for the current elderly population will not suffice for those who are aging now (Mellor & Rehr, eds., 2005).
The sheer numbers of individuals entering later adulthood and their new breed of needs has powerful implications for the profession. The needs themselves create a necessity along with the fact that this country has never before experienced such a large number of individuals entering into old age simultaneously (Mellor & Rehr, eds., 2005). This generation has a history of activism, and even as they age, will most likely continue to make demands on the profession, which will instigate new means of measuring "grief, loss and loneliness, and depression" (Whiston, 2009, p. 404). An abundance of research determined that this group will continue to break the mold as they age (Frey, 2010).
This group will most likely not be the bingo players of today's elderly population, and along with their unusual need for activity, they may also approach psychological issues differently (Richman, 2012). Barbera (2012) claimed the greatest psychosocial needs of this population will be social connectedness, their vastly different preferences as compared to previous aging populations, their penchant toward continuing education and their love of activism, especially as it pertains to their physical and mental health care. They will want to be centrally involved in any decisions made about their care and they will demand to be educated on the meaning and results of any assessment used to make decisions about their care.
The Baby Boomer generation will expect support systems, especially those that advocate and facilitate self-support, and in concert with their awareness of the mind body connection, they may instigate significant change in the counseling profession, specifically, how psychological issues are assessed (Barbera, 2012).
Barbera, E. F. (2012). 10 anticipated psychosocial needs of baby boomers. Long-Term Living: For the Continuing Care Professional, 61(2), 32-33.
Frey, W. H. (2010). Baby Boomers and the new demographics of America's seniors. Generations, 34(3), 28-37.
Mellor, M. J., & Rehr, H. (Eds.). (2005). Baby boomers: Can my eighties be like my fifties? New York, NY: Springer.
Richman, A. (2012). Are Wii ready for the baby boomers? Long-Term Living: For the Continuing Care Professional (LONG TERM LIVING), 2012 Apr; 61(4): 24-6, 61(4), 24-29.
Whiston, S. C. (2009). Principles and applications of assessment in counseling (3rd ed.). Belmont, CA: Brooks/Cole, Cengage Learning.
Death, in medical terms, takes place when vital functions cease. This includes brain activity, respiration, and heartbeat (Santrock, 2008). Personally I support the idea that death, for all significant intents and purposes occurs at the cessation of higher cortical functioning. Lawyers and the legal system may argue over what constitutes death, so advanced directives will help individuals and their families from the intrusive nature of the law and lawyers at a time when sensitivity and privacy are preferred by most families. Ethically, it is the duty of medical practitioners to do whatever is necessary to support life unless directed otherwise expressed by the individual in a living will or other type of legally acceptable directive.
In some Australian Aboriginal communities, the morning ceremonies can be elaborate and complex (Jacklin, 2005). Community members may burn the camp and move to another location. Once an individual is deceased, it becomes taboo to mention his or her name for a specified amount of time, perhaps forever. Although the dead remain in the minds of the family and community, they may not be openly mentioned or discussed. Most often, the dead individual's belongings are burned (Jacklin, 2005).
Australian Aborigines believe they are a part of the earth. Typically, these people do not fear death and believe it is a time when the spirit is released to its sacred home. Still, though, as in many cultures, the death of family and loved ones causes tremendous grief and sadness (Northern Territory Government - Australia (NTGA), n.d.). Failing to conduct ceremonies properly may cause the deceased spirit to become trapped and fail to progress into the spirit world. Because of this, spiritual ceremonies are taken seriously (NTGA, n.d.). Deceased individuals are given a morning name which is used in place of the name they used throughout their lifetime (Jacklin, 2005). Sometimes, other individuals with the same name will take a new name (NTGA, n.d.).
Although various populations have radically different ceremonies and ritualistic ways of coping with death, for most people, the death of family or a loved one is a deep loss, even when it is a renewal or spiritual progression or reward for the deceased (Stroebe, 2010). Even in American culture, honoring the dead comes in many different presentations, and various ethnicities practice rites that others might find offensive.
As a counselor, it is important to acknowledge and understand the significance and far reaching implications of losing a loved one. Such loss predisposes an individual to psychological and physical ill health (Rudlow, 2012). Although research identifies processes of coping after the loss of a loved one (Stroebe, 2010), of critical importance is understanding there is no one way to grieve loss or the process of dying. Encouraging a client to do either according to personal expectations could cause potential harm (Kübler-Ross, 1970; 1985; 1981)
Jacklin, M. (2005). Collaboration and closure: Negotiating Indigenous mourning protocols in Australian life writing. Antipodes: a North American Journal of Australian Literature, 19(2), 184-191.
Kübler-Ross, E. (1970). On death and dying. [New York]: Macmillan.
Kübler-Ross, E. (1981). Living with death and dying. New York: Macmillan.
Kübler-Ross, E. (1985). On children and death. New York: Collier Books.
Northern Territory Government - Australia. (n.d.). Indigenous Traditional Religions. Global Dialogue Foundation. Retrieved November 18, 2012, from http://www.globaldialoguefoundation.org/
Rudow, H. (2012). The bereaved at greater risk of heart attack after loss. Counseling Today: CT Daily. Retrieved from: http://ct.counseling.org/2008/01/working-through-grief/
Santrock, J. W. (2011). A topical approach to life-span development (3rd ed.). New York, NY: McGraw-Hill.
Stroebe, M. S. (2010). Bereavement in family context: Coping with the loss of a loved one. Family Science, 2(3/4), 144–151. doi: 10.1080/19424620.2010.576081
Individuals and organizations require adequate care and effectiveness in mental health care now more than ever, and assessing outcomes has become an integral part of counseling practice (Sederer, Dickey, & Eisen, 1997). Several aspects of accountability are critical in counseling practice (Whiston, 2009). Selecting an appropriate assessment instrument is significant, considering this choice determines the appropriateness and pertinence of information obtained from the assessment (Whiston, 2009). Prior to making the selection, it is, of course, crucial to have at least a fundamental understanding of the client, especially if they are a member of a diverse population (American Counseling Association (ACA), 2005). The extent of their enculturation is important as well. For example, not all Hispanics are the same. Some may be far more entrenched in tradition than others who may be fully assimilated into the majority culture. These factors are important when considering utilizing an assessment on any individual (ACA, 2005).
Monitoring Outcomes and Patient Progress
Monitoring outcomes and patient progress is part of accountability as well (Lambert & Hawkins, 2004). For example, if a counselor implements an intervention with information partly gained from a particular assessment format, and the client seems to be less involved with each subsequent session, reassessment would be necessary. Ongoing assessment (even informal) helps the counselor to be sensitive to the client's ongoing needs (Whiston, 2009). If the client is not progressing according to the plan, some element of the intervention may be ineffective.
Ongoing evaluation may be especially important when working with an individual whose insurance provides for limited counseling sessions (Lambert & Hawkins, 2004) or when counselors are required to document their effectiveness (Whiston, 2009). Selecting an appropriate instrument can be daunting under the best of conditions, and Lambert & Hawkins (2004) suggest using a conceptual model that characterizes instruments by "content, source, method of data collection, and time orientation" (para. 4). Lambert & Hawkins believed that basing selection choice on these characterizations facilitated better informed selection. Whichever instrument is chosen, routine client monitoring may prove to be the single most critical evaluative tool counselors have. When clients fail to progress, it may be time to return to the assessment drawing board and reevaluate the treatment, the client, and the counselor's effectiveness.
The Routine of Measuring Outcomes
As mentioned by Sederer, Dickey, and Eisen (1997), outcomes can be elusive and difficult to measure. These authors found that implementing a routine process for monitoring outcomes was critical to improving the care counselors provide to their clients. Furthermore, it increased consumer (client) satisfaction, as well as upholding the profession's standards (Sederer, Dickey, & Eisen, 1997). I thought Sederer, Dickey, and Eisen's system seemed particularly practical to implement. Basically, these authors suggest using a routine system that is relevant in practice, considers unique cultural contexts, is inexpensive and easy to use, is sensitive to change, and involves the client. I appreciate the idea of using this client monitoring as part of a counselor's routine with the client. With this process in mind, the counselor is able to keep abreast of client progress and provide effective treatment, which is valuable to the counselor's livelihood as well as that of the profession (Whiston, 2009).
American Counseling Association. (2005). ACA Code of Ethics. Retrieved from http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx
Lambert, M. J., & Hawkins, E. J. (2004). Measuring outcome in professional practice: Considerations in selecting and using brief outcome instruments. Professional Psychology: Research and Practice, 35, 492-499. doi: 10.1037/0735-7028.35.5.492
Sederer, L. I., Dickey, B., & Eisen, S. V. (1997). Assessing outcomes in clinical practice. Psychiatric Quarterly, 68(4), 311-325.
Whiston, S. C. (2009). Principles and applications of assessment in counseling (3rd ed.). Belmont, CA: Brooks/Cole, Cengage Learning
The two individuals interviewed for this paper, David and Katy, have several factors in common, but perhaps the two most salient are their high socioeconomic status and their good health. Clearly, these factors and a few others, including companionship and the ability to access resources, have a decided impact on quality of life throughout retirement (Bowling, 2007; Lowis, Edwards, & Burton, 2009; Reitzes & Mutran, 2004; Santrock, 2008). This paper will discuss the findings from two interviews with retirees and provide an explanation of sociocultural factors that affect retirement. Finally, it will identify and explicate factors that contribute to adjustment in retirement.
Retirement Lifestyle: A Brief Synopsis
Financial and Psychological Preparation
Both of my interviewees retired at a relatively young age. Katy developed and then sold a successful business, and David retired after several years of successful business ventures. Both are healthy, although David had a five-year bout with prostate cancer several years ago, which was a motivating factor in his decision to retire early. Both prepared financially for retirement, although in different ways: David saved money from each transaction, and Katy invested in franchising her business, knowing it would provide financial reward at a later time. Neither of the interviewees prepared psychologically for retirement, although both looked forward to being relieved of work-related responsibilities. David reported that contending with a cancer diagnosis makes retirement seem somewhat inconsequential, although thoroughly enjoyable. I was not aware of any differences attributable to gender, except that Katy seems to have a stronger sense of autonomy, which seems more typical in strong women than in their male counterparts, however, this could be solely an aspect of personality rather than gender.
Social Activities and Participation
Both interviewees remain active. David and his wife spend ten months out of the year on their boat. For them, this is a fulfillment of a dream they shared for many years. During the other two months and while sailing, they have many close friends with whom they visit and share a deep sense of camaraderie. They have few ordinary responsibilities, but are deeply committed to each other and the welfare of their friends. Katy is a single woman with grown children, with whom she maintains close relationships. She has become somewhat of a local philanthropist, providing financial support for various local causes, she volunteers to help older adults, and travels. She has a strong spiritual beliefs and actively engages in life experiences.
Thoughts and Feelings About Retirement
Katy and David believe their retirement is a stage of life in which they continue to evolve and grow. They acknowledge that in many ways, life has not changed too much; they continue to have challenges, face their own shortcomings, and contend with the more pedestrian issues that people face on a daily basis. David claims he will stop sailing at some point, and he and his wife have started to talk about how they intend to give something back to humanity. They are thankful for their abundance, and have a growing personal need to help others. Katy, on the other hand, is fully engaged in the process of giving to others. This, more than any other aspect of retirement, gives her direction, spirit, happiness, wisdom, and a sense of deep fulfillment.
Individual and Sociocultural Factors
Several factors exist that seem to affect deeply the character of retirement: health, individual perspective, finances, and companionship. Furthermore, I would be remiss if I did not mention that both individuals are White, and have, perhaps, directly or indirectly availed themselves to the benefits of being part of the majority culture. Both interviewees are healthy, have positive outlooks for the future, above average financial savings, and loving families, all of which help individuals fare better in retirement (Reitzes & Mutran, 2004). Santrock (2008) claimed women who have spouses or partners seem to adjust to retirement more easily. Katy, long divorced, seems more vital than David, and is obviously not represented by that claim.
Retirement is multidimensional, and similar to aging, is most accurately expressed as a process mediated by physical and psychological health, cognitive functioning, access to resources, social and family support systems, and general attitude toward life (Bowling, 2007). Furthermore, maintaining a sense of control has powerful implications in general life quality, as does having an overall faith in life and humanity (Lowis, Edwards, & Burton, 2009; Reitzes & Mutran, 2004). Health in retirement is perhaps the single most significant predictive factor of an individual's ability to cope with life's challenges (Lowis, et al., 2009). The retirees interviewed for this paper were extremely healthy, and one of them valued health more than the average person by virtue of his experience with a life-threatening illness.
In some ways, my interviewees have failed retirement in the traditional sense (Yoder-Wise, 2011). David talks about perhaps engaging in a few more ventures that will allow he and his wife to fully finance their dream of creating a scholarship fund for families who cannot afford to pay for their children's college educations. Katy, for all intents and purposes, continues to work full-time, although not for monetary gain. The success of retirement depends upon a multitude of physical, psychological, and circumstantial factors. It is evident, however, that having access to resources and financial security provides extraordinary experiences that can contribute to the successful navigation of retirement.
Bowling, A, (2007). Aspirations for older age in the 21st century: What is successful aging? International Journal of Aging & Human Development, 64(3), 263–297.
Lowis, M. J., Edwards, A. C., & Burton, M. (2009). Coping with retirement: Wellbeing, health and religion. Journal of Psychology, 143(4), 427–448.
Reitzes, D. C., & Mutran, E. J. (2004). The transition to retirement: stages and factors that influence retirement adjustment. International Journal of Aging & Human Development, 59(1), 63–84.
Santrock, J. W. (2008). A topical approach to life-span development (3rd ed.). New York, NY: McGraw-Hill.
Yoder-Wise, P. S. (2011). Failing retirement: The baby boomers' next best thing. Journal Of Continuing Education In Nursing, 42(5), 194. doi: 10.3928/00220124-20110421-01
When discussing the effects of ethnicity, it is important to consider the unbalanced number of ethnic minorities who fall into low socioeconomic status (SES) (Santrock, 2008). Middle and upper income class students do better in school than do their low SES counterparts (Santrock, 2008). The socioeconomic status of children has a more significant influence than does cultural affects. Furthermore, children in poorer neighborhoods often attend class in older, unkempt buildings (Santrock, 2008).
Ethnic minority students are forced to contend with discrimination and stereotyping by other students and by teachers and even with tremendous motivation, many children find it difficult to meet average expectations (Santrock, 2008). Low socioeconomic status presents a range of difficulties including bias and teachers' lower expectations for students in this category (Auwater & Aruguete, 2008). Although this seemed like a weak study, there may be some truth to the claim, although polling teachers from one Midwestern town certainly limits the study's value. Students living in poverty face challenges at home that can interfere with learning at school. When children live in a familial culture that fails to see the value in education, when they are malnourished, or live in less than ideal neighborhoods, they tend to fare worse than their middle class counterparts (Santrock, 2008)
Strategies to Mitigate Negative Influences
Mitigation of the negative consequences of minority status or poverty is not always as easy as implementing a theory or a particular curriculum, although taking into consideration the student's unique context, there are several approaches to inspiring achievement (Santrock, 2008). Offering extrinsic awards, in the classroom and at home might engage the student in a greater effort to work a little harder. When children are given opportunities and responsibilities, they may take pride in their accomplishments. Instilling a sense of self-efficacy can help children believe they can accomplish extraordinary tasks, which may be a first step in the task's actual accomplishment.
I appreciated Santrock's (2008) idea of making changes in the classroom that contributed to children's tendency to segregate themselves at school. For example, mixing children in groups so that they have to work with classmates from a variety of ethnicities can encourage personal contact with diversity.
Auwater, A. E., & Aruguete, M. S. (2008). Effects of student gender and socioeconomic status on teacher perceptions. Journal of Educational Research, 101(4), 243–246.
Santrock, J. W. (2011). A topical approach to life-span development (3rd ed.). New York, NY: McGraw-Hill.
Choosing the most appropriate test that considers the unique context of the child, adolescent, or adult can be a daunting task for counselors (Cicchetti, 1994). In addition to determining an assessment's reliability and validity, determining the extent of qualifications necessary for its administration and scoring are equally critical. The following review of the Beck Depression Inventory FastScreen for Medical Patients (BDI-FastScreen) will examine general information for the instrument, its purpose and nature, technical considerations, and practical and general evaluation.
A. Title: BDI-FastScreen for Medical Patients (Beck, Steer, & Brown, 2003).
B. Author: Aaron T. Beck, Robert A. Steer, and Gregory K. Brown (Beck, Steer, & Brown, 2003).
C. Publisher: PsychCorp, A brand of Harcourt Assessment, Inc., 19500 Bulverde Road, San Antonio, TX (Beck, Steer, & Brown, 2003).
D. Forms, groups to which applicable: Previously called the Beck Depression Inventory for Primary Care and based on the Beck Depression Inventory-II. Designed for population ages 12 - 82 (Beck, Steer, & Brown, 2003).
E. Practical features: The BDI-FastScreen for Medical Patients is a self-report questionnaire containing seven psychological depression symptoms (Scheinthal, Steer, Giffin, & Beck, 2001). It is used by physicians assessing somatic and behavioral symptoms that may be associated with medical, biological, or substance abuse problems. The seven items are rated on a four-point scale (0-3) and assess frequency, over the past two weeks, of feelings of sadness, pessimism (hopelessness), sense of failure, loss of a sense of pleasure, loss of self-confidence, self-blame, and suicidal ideation. The items correspond to the DSM-IV-TR (Beck, Steer, & Brown, 2003).
F. General type: Serves as an indicator of depression as a result of medical, biological, or substance abuse problems (Beck, Steer, & Brown, 2003).
G. Date of publication: 2002 (Beck, Steer, & Brown, 2003).
H. Costs, booklets, answer sheets, scoring: 2003 price data: $67 per complete kit, including manual and 50 score forms; $39 per manual; $39 per 50 record forms; $43 per 50 scannable record forms; quantity discounts available. Scoring is easily accomplished by summing the point values from the seven items, and interpreting total scores (Beck, Steer, & Brown, 2003).
I. Time required to administer: Five minutes (Beck, Steer, & Brown, 2003).
J. Purpose for which evaluated: Designed to screen patients for depression that may be related to medical illness, chronic condition, or substance abuse (Beck, Steer, & Brown, 2003).
Purpose and Nature of the Instrument
The BDI-FastScreen for Medical Patients (BDI-FastScreen), previously known as the BDI-Fast Screen was specifically designed for use in medical or clinical settings to identify the presence of depression in patients (ages 12-82) with existing biological, medical, or substance abuse problems (Hennessy & Pallone, 2003; Whiston & Eder, 2003).
Description of Test, Items, and Scoring
The BDI-FastScreen is a self-administered, five-minute test composed of seven items taken from the Beck Depression Inventory-II (BDI-II) that uses the diagnostic criteria for a major depressive disorder (MDD) in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) as a comparison (Beck, Steer, & Brown, 1996; Whiston & Eder, 2003). Patients report using a Likert-type scale that varies between 0 (not present) to 3 (severe) on test items related to sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal thoughts (Whiston & Eder, 2003). Scoring is easily accomplished by summing total scores, which are interpreted according to the manual guidelines, as follows: 0-3 minimal, 4-8 mild, 9-12 moderate, and 13-21 severe depression (Whiston & Eder, 2003).
Use in Counseling
The BDI-FastScreen is a quick and easy-to-use instrument for screening adolescent and adult depressive symptoms related to biological, medical, or substance abuse problems (Hennessey & Pallone, 2003; Whiston & Eder, 2003). The authors warn that the BDI-FastScreen is neither a substitute for the BDI-II, nor is it a diagnostic tool, but is a reliable information source when used as intended. Clinicians should give primacy to complete patient evaluations as a fundamental source of evaluation (Whiston & Eder, 2003). Although the test is reportedly highly reliable, it may not adequately differentiate adequately between major and less severe depressive symptoms. Non-zero responses should be evaluated for further examination (Hennessey & Pallone, 2003).
The authors used four different groups for the normative sample for the BDI-FastScreen (Whiston & Eder, 2003). The first of group (a) consisted of 50 patients referred to psychiatric consultation after hospitalization for a medical condition. The second group (b) was 94 outpatients referred from family practices; the third (c) consisted of 100 pediatric patients between the ages of 12 and 17 scheduled for medical check-ups, and the fourth group (d) was comprised of 120 patients from a university outpatient facility. One reviewer (Hennessey & Pallone, 2003) concluded that the normative sample was inadequate because in the combined sample, 96 patients were known to have major depression and 268 had no depressive symptoms. Furthermore, the same reviewer found fault with 120 outpatients culled from the same medical facility and participants from all four samples were from one geographical location (Hennessey & Pallone, 2003). No information is provided for the selection methods and the criteria by which participants were selected.
The authors used four different groups for the normative sample for the BDI-FastScreen (Whiston & Eder, 2003). The first of group (a) consisted of 50 patients referred to psychiatric consultation after being hospitalized for a medical condition. The second group (b) was 94 outpatients referred from family practices; the third (c) consisted of 100 pediatric patients between the ages of 12 and 17 scheduled for medical check-ups, and the fourth group (d) was comprised of 120 patients from a university outpatient facility. The coefficient alphas for the groups were a = .86, b = .85, c = .88, and d = .86. The manual for the test did not provide any additional sources for reliability evidence (Hennessey & Pallone, 2003). Some controversy exists over the lack of test-retest studies, especially in light of ongoing concerns regarding patients' ability to recall previous answers, given the abbreviated seven-item format. The authors report no response set effect, although that information was derived from a 1967 study (Hennessey & Pallone, 2003).
The authors of the BDI-FastScreen correlated this test with other instruments that measure depressive symptoms to demonstrate construct validity (Hennessey & Pallone, 2003). In three different studies, correlations were r = .62, r = .86, and a correlation to a DSM-IV-TR diagnosis for mood disorder was r = .69 (Hennessey & Pallone, 2003). A high correlation between the BDI-FastScreen and the Beck Anxiety Inventory for Primary Care suggested both evaluate the same variable, which may be anxiety rather than depression (Whiston & Eder, 2003). The test authors assert that the 40 years of evidence supporting the Beck assessments in general should be a gauge of validity, however that claim should not be the sole representation of validity for this specific instrument (Hennessey & Pallone, 2003). The same samples used for determining internal consistency were used to evaluate validity, and Hennessey and Pallone (2003) believed validity cannot be accurately gauged until additional studies are undertaken with a wider and more representative sample.
The BDI-FastScreen has been successfully implemented in a variety of patient groups with biological and medical issues (Whiston & Eder, 2003), including patients with multiple sclerosis (Benedict, Fishman, McClellan, Bakshi, & Weinstock-Guttman, 2003), patients with chronic pain (Poole, Bramwell, & Murphy (2009), geriatric medical patients (Scheinthal, Steer, Giffin, & Beck, 2001), and as a useful assessment for determining mood disorders in HIV patients with chronic pain (Krefetz, Steer, Jermyn, & Condoluci, 2004). Further study may be warranted for implementation in other specialized populations (Whiston & Eder, 2003). Although no evidence exists in support of cross-cultural generalizability, it does appear to be adequate across sex and age categories.
Qualifications of Examiners
The BDI-FastScreen for Medical Patients (BDI-FastScreen) is a cost-effective, focused evaluation tool that can be self-administered in five minutes and easily scored (Segal & Hilsenroth, 2004). The BDI-FastScreen is listed for purchase with a B Qualification level, which means that the purchaser must retain membership in a professional organization that promotes or requires appropriate assessment training and qualification (Pearson Education, Inc., 2012). If the purchaser does not retain such a membership, he or she must have a master's degree in a field related to the intended use of the assessment (Pearson Education, Inc., 2012). This may include a master's degree in psychology, education, occupational therapy, speech-language pathology, or social work. There are no licensing requirements or special training specific to the BDI-FastScreen, and although qualification for purchase exists, the scoring can be done by office staff (Pearson Education, Inc., 2012).
As the vendor of the BDI-FastScreen, Pearson Education, Inc. (2012) expressed its commitment to maintaining standards in testing according to the American Educational Research Association, the American Psychological Association, and the National Council on Measurement in Education. To facilitate the ethical and appropriate use of assessments, purchasers must use an established qualification system that requires the purchaser to register and submit to a verification of qualifications. The purchaser must comply with the registration process by completing a user acceptance form that requests basic demographic information as well as the primary work setting, professional degrees obtained, training or coursework completed in assessments, licenses or certifications received, and active organization memberships (Pearson Education, Inc., 2012).
The answer sheet is a one page form whereon the examinee's name, age, gender, marital status, occupation, and level of education is documented. The BDI-FastScreen has seven items listed in two columns (Hennessey & Pallone, 2003). It can be easily attached to a clipboard along with other intake forms, if the clinician deems appropriate. Furthermore, the assessment can be read to clients who cannot read English (Whiston & Eder, 2003). The answer sheet contains a warning about the black and green ink colors on the form indicating the copy is not infringing on copyright laws.
The manual is easy to understand although may pose some difficulty for untrained examiners (Hennessey & Pallone, 2003). Examiners should be particularly attentive to non-zero responses to the items regarding pessimism and suicidal thoughts (Hennessey & Pallone, 2003). The manual clearly explains how to add the scores from the seven test items to find the total score (Segal & Hilsenroth, 2004). The symptoms measured include: sadness, pessimism, past failure, loss of pleasure self-dislike, self-criticalness and suicidal thoughts (Strauss, Spreen, & Sherman, 2006). Each question is marked 0 through 3 using a Likert-type scale, and the highest score is 21 if the client responded with a 3 to all of the items. The lowest score is zero if the client answered each question with a 0 (Segal & Hilsenroth, 2004). The manual provides guidance on total test scores as follows: 0-3 is minimal; 4-8 is mild; 9-12 is moderate, and 13-21 is severe depression (Whiston & Eder, 2003). Some research indicates that when utilizing this assessment for individuals of diverse populations, there may be alternative cut scores, and the counselor may want to check validity for these populations (Strauss, Spreen, & Sherman, 2006).
Comments of Reviewers
The BDI-Fast Screen is a refined version of BDI-II in a checklist format used similar to the way a clinician would utilize the DSM-IV (Hennessey & Pallone, 2003). This instrument is successful in evaluating the presence of depressive symptoms rather than their severity. Because of its ease of use by general practitioners, caution is advised to prevent excessive or inappropriate diagnoses of depressive disorders without further evaluation, especially if pharmacological treatment is warranted (Hennessey & Pallone, 2003). For example, when a patient is initially diagnosed with cancer, he or she may report significant emotional episodes of sadness, anger, pessimism, grief, and other feelings that are part of the normal process of coping with the tremendous shock of such a diagnosis. These experiences must be differentiated from major depressive tendencies. Consequently, the results of the BDI-FastScreen must be interpreted contextually (Hennessey & Pallone, 2003). The authors of this instrument should strongly discourage practitioners from making presumptions based on interpreting scores out of context (Hennessey & Pallone, 2003).
The BDI-FastScreen serves a special population in which depressive symptoms must be differentiated as a result of a medical diagnosis or alcohol or substance abuse. Some reviewers (Farmer, 2001; Whiston & Eder, 2003) believed the psychometric properties of the BDI-FastScreen and those of the BDI-II are closely aligned, and neither manual provides adequate psychometric information to justify its use. Even though the foundation of this assessment rests upon the well-established Beck reputation, the research that has been done on the BDI-FastScreen is somewhat limited (Hennessey & Pallone, 2003). Furthermore, the samples that have been studied are small and inadequately represent the diversity of individuals with substance abuse and other medical conditions (Hennessey & Pallone, 2003; Whiston & Eder, 2003). Forthcoming research on the BDI-FastScreen undoubtedly will include a more accurate representation of diverse populations and enlist participants from a wider range of geographical locations (Hennessey & Pallone, 2003). Regardless, the positive reviews of the BDI-II can be applied to the BDI-FastScreen for clinicians who seek further evaluative information (Whiston & Eder, 2003).
One reviewer (Whiston & Eder, 2003) concluded the cutoff scores are somewhat ambiguous and the manual contains an inadequate amount of information on the scoring categories of minimal, which ranges from 0 to 3; the mild category, ranging between 4 and 8, moderate between 9 and 12, and severe depression between 13 and 21. This same reviewer believed additional research was warranted on assessing the ability of the BDI-FastScreen to make a distinction between patients with major depressive disorders and those experiencing normal reactions and appropriate coping mechanisms (Hennessey & Pallone; Whiston & Eder, 2003).
The BDI-FastScreen was specifically designed to fill a need in medical or clinical settings to identify the presence of depression in adolescents and adults with existing biological, medical, or substance abuse problems (Hennessy & Pallone, 2003; Whiston & Eder, 2003). The foundational research for this instrument is based on years of empirical study of the BDI-II and this abbreviated form shares its reliability and validity data. The 7 items, taken from the BDI-II address sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal thoughts (Whiston & Eder, 2003) and were designed to correspond to the diagnostic criteria for major depressive disorders defined in the DSM-IV (Hennessey & Pallone, 2003). As previously discussed, additional research is necessary to assess the BDI-FastScreen's ability to differentiate patients with major depressive disorders from those experiencing normal biological or psychological reactions to diagnosis or substance abuse (Whiston & Eder, 2003). Inasmuch, the recommendations of the authors should be heeded, that the BDI-FastScreen is neither a substitute for the BDI-II, nor is it a diagnostic tool, but it is a reliable information source when used as intended. One reviewer (Whiston & Eder, 2003) believed the high correlation between this instrument and measures of anxiety may imply that the BDI-FastScreen measures a construct that occurs in other psychological disorders. If this were the case, its value as a screen for depression in medical patients may be overestimated (Hennessey & Pallone, 2003).
Specifically designed to screen for depression in patients with biological, medical, or substance abuse problems, the BDI-FastScreen is a valuable tool that may also be used in counseling practice. Its ease of use and simple scoring procedures demonstrate its usability as a quick and easy assessment designed to screen a special population for depression. Leaning on the time-honored reputation of the Beck assessments and developing a reputation in its own right, the BDI-FastScreen should find widespread applicability for the populations for which it was designed. Its limitations should be considered, and it is not a diagnostic tool, but a source of valuable information used in concert with a comprehensive clinical evaluation (Whiston & Eder, 2003).
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
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Hennessy, J., J. & Pallone, N., J. (2003). Review of the BDI-FastScreen for Medical Patients. In B.S. Plake, J.C. Impara, & R.A. Spies (Eds.), The seventeenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/
Krefetz, D. G., Steer, R. A., Jermyn, R. T., & Condoluci, D. V. (2004). Screening HIV-infected patients with chronic pain for anxiety and mood disorders with the Beck Anxiety and Depression Inventory-Fast Screens for medical settings. Journal of Clinical Psychology in Medical Settings, 11(4), 283-289. doi: 10.1023/B:JOCS.0000045348.28440.82
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Scheinthal, S. M., Steer, R. A., Giffin, L., & Beck, A. T. (2001). Evaluating geriatric medical outpatients with the Beck Depression Inventory-FastScreen for Medical Patients. Aging & Mental Health, 5(2), 143-148. doi: 10.1080/13607860120038320
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Whiston, S., C. & Eder, K. (2003). Review of the BDI-FastScreen for Medical Patients. In B.S. Plake, J.C. Impara, & R.A. Spies (Eds.), The seventeenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/
Internet and Advertising
I found it particularly interesting that adolescents become more conforming, especially to their peer's antisocial values (Santrock, 2008). This has a definitive effect in concert with the influence of the media. When even half of an associated peer group becomes enamored with a trendy product, the rest of the group will quickly be made aware of its salience. As the media has become pervasive in the lives of children and adolescents, its influence and effects have become long-term and far-reaching (Santrock, 2008). Access and exposure to the media is excessive, and parents have far less control over their children's exposure, which has become "a new, massive, and complex virtual universe, even as they carry on their lives in the real world" (Greenfield & Yan, 2006, p. 391). Although for many children, the internet and media provide potential danger and a misuse of experience, for others, the bounty of valuable information in this virtual universe has potential, if not actual, benefit (Greenfield & Yan, 2006).
Barker (2006) used information from 2006, which, considering how drastically the demographics for online social networking in the last few years, I imagine their statistics are already outdated. Suffice it to say, many young children and most adolescents have unrestrained use of the internet. As far back as 2006, more than half of the adolescents who use the internet have an online presence, specifically on social networking sites (Barker, 2006). Not only has this online access changed the amount of easily accessible information, it has also introduced a new manner of communication wherein individuals are free to express thoughts and ideas without experiencing the ordinary repercussions of face-to-face interactions.
Social Networking and Identity
The internet and especially social networking sites have changed the formation of social identity, specifically how individuals may become part of a group that may or may not have face-to-face experiences or communication (Barker, 2006). Exposure to media has altered the general experience of children and adolescents, exposing them to sex (as well as safe sex) and sexuality, violence, the pros and cons of substance use and abuse, body image, and consumerism (Strasberger, 2010). The repercussions of these exposures is powerful and in many cases, life altering. The media and the internet provide potential for positive and negative experiences, but the most salient issues for children, and more pervasively, perhaps, for adolescents, "have all been transferred to and transformed by the electronic stage" (Subrahmanyam, & Greenfield, 2008, p. 139).
Media, the Internet, and Sitting Around on Expanding Hindquarters
Finally, the media and internet have altered the physical growth of children and adolescents to the point where more children than ever are morbidly obese, and many more are overweight (Yu, 2011). This may be because of a lack of exercise and physical activity and eating all the junk food they see advertised on television and online. In many households, fresh air and outdoor play has been replaced by electronic entertainment and healthy foods substituted with the best and brightly advertised product.
Barker, V. (2008). Older adolescents' motivations for use of social networking sites: The influence of group identity and collective self-esteem. Paper presented at The International Communication Association Annual Conference, Montreal, Canada.
Barnett, C. (2009). Towards a methodology of postmodern assemblage: Adolescent identity in the age of social networking. Philosophical Studies in Education 40, 200–210.
Greenfield, P., & Yan, Z. (2006). Children, Adolescents, and the Internet: A New Field of Inquiry in Developmental Psychology. Developmental Psychology, 42(3), 391-394. doi: 10.1037/0012-16188.8.131.521
Strasberger, V. (2010). Children, adolescents, and the media: seven key issues. Pediatric Annals, 39(9), 556–564. doi: 10.3928/00904481-20100825-06
Subrahmanyam, K., & Greenfield, P. (2008). Online communication and adolescent relationships. Future of Children, 18(1), 119–146.
Yu, H. (2011). Parental communication style's impact on children's attitudes toward obesity and food advertising. JOURNAL OF CONSUMER AFFAIRS; SPR, 2011, 45 1, P87-p107,, 45(1), 87-107.