Thursday, November 29, 2012
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