Clinical Assessment of Child and Adolescent Personality and ...

chapter 5 Planning the Evaluation and Rapport Building83ment battery. For example, if an assessmentis primarily intended to determine schoolplacement, then the focus of the evaluationwill not be to determine whether ornot a psychiatric diagnosis is warranted,but to determine whether or not the childmeets the eligibility requirements of theschool system. The assessor may feelthat more information is needed to makeappropriate recommendations to meet achild’s psychological and educational needsthan is required by these criteria. However,enough information to determine the eligibilityshould be part of the assessment,if this is the primary referral question.In our experience, it is not uncommonfor an otherwise sound and competentlyconducted evaluation to be useless forthe specific purposes for which a childwas referred.There are many other examples showinghow the intended use of the assessmentinformation determines the measures tobe used. This may be as broad as definingwhat areas need to be covered for acertain purpose (e.g., some residentialtreatment centers require a personalityassessment prior to acceptance) to as specificas requiring certain tests (e.g., someschool systems require specific tests to begiven for special education placement).The assessor should not give a test that,in his or her professional judgment, isinappropriate for a particular use or isinappropriate for a particular client.However, if, at the time of referral, theintended use of the assessment is clarifiedand there is some question as to howappropriate certain requirements are fora given case, the assessor can attempt toaddress these issues before beginning theevaluation.Often the person or agency referring achild or adolescent for testing is not surehow the test results will be used. Instead,the child is referred because the agency isunsure of the nature of a child ’ s problem (oreven whether there is a problem), and thereferrer is unsure of what can be done tohelp the child. There are many variationson this theme, but, in essence, the goal ofthe assessment is to diagnose the source ofa child ’ s difficulty and to make treatmentrecommendations based on this diagnosis.In Chap. 3, we discussed many importantissues in making diagnostic decisions.However, Martin (1988) provides a succinctand practical analysis of the specificgoals involved in diagnosis. These areto (1) predict future behavior, (2) differentiatebetween abnormal and normalbehavior, (3) make differential diagnoses,and (4) delineate individual differencesin competencies and disabilities. Martinalso provides some interesting recommendationsfor planning the evaluationto maximize the reliability of the diagnosticprocess. These are summarized inBox 5.1.Description of ReferralProblemsIn addition to understanding the purposeof the testing referral, it is also importantto obtain an initial description of the difficultiesthat a child is experiencing thatled to the referral. One of the reasons thatclinical assessments are so fascinating isthat, if done right, the assessment is a typeof scientific inquiry. Based on the intakeinformation, the assessor should havesome initial hypotheses for understandinga given case that will be tested during theevaluation. These hypotheses will guidethe initial planning of the evaluation andinitial test selection. As in any good scientificendeavor, we must be clear of thedata that would support and those thatwould not support the various hypotheses.In contrast to many other scientific enterprises,however, the hypotheses can, andshould, change during the investigation.