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Adolescent Mental Health & Assessments 11/8/2016
Flowers & KimbellTPA 2016 1
Adolescent mental health and behavior:
Getting the most from your assessments
Texas Psychological Association Annual Convention
November 2016Presented by:
Anise Flowers, PhDAnne-Marie Kimbell, Ph.D.
AgendaOverview of MMPI-A-RF
Overview of BASC-3 Family
Introduction to BASC-3 Intervention Guide and Flex Monitor
Case Study Application
Image by Photographer’s Name (Credit in black type) or Image by Photographer’s Name (Credit in white type)
MMPI-A-RF Training Slides, University of Minnesota Press, 2016. Copyrights for all MMPI® and MMPI-A-RF™ materials are held by the Regents of the University of Minnesota.
MMPI-A-RF Product Overview
Assessment of major symptoms of psychological dysfunction, personality characteristics, and behavioral tendencies in adolescents.
Administer to: Individuals 14-18 years old
Qualification Level: C – PhD psychologists
Completion Time: 25 – 30 minutes computer-administered30-45 minutes paper-and-pencil
Reading Level: 4.9th grade (Lexile average), 4.4th grade (Flesch-Kincaid)
Administration: Q-global, Q Local, paper-and-pencil
Scoring Options: Q-global, Q Local, Mail-In, Hand-scoring
Report Options: Score and Interpretive Reports
Features & Enhancements
• Most up-to date, empirically-based personality assessment for adolescents
• Mirrors the structure of the MMPI-2-RF, the most current version for use with adults
• Broad-based, comprehensive assessment includes• 48 empirically validated scales• 7 validity indicators
• Linked to current models of psychopathology& personality
• Developed for use in a variety of clinical, forensic, andschool settings
• Customizable reporting options include:• 10 gender-specific comparison groups• Comparison group creation• User-defined parameters for item-level and critical response reporting
Factors in the Development of the MMPI-A-RF• Need to reduce the high degree of MMPI-A scale
intercorrelation• Reduce redundant influence of demoralization factor
across scales• Reduce item overlap between scales• Reduce scale content multidimensionality
• Develop a test based on roughly 250 items• Test length of MMPI-A viewed by some as a
significant disadvantage• Develop an adolescent self-report measure
comparable to the MMPI-2-RF but adapted to include measures uniquely related to adolescent psychopathology
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MMPI-A-RF Project
• Project formed in late-2007 by University of Minnesota Press, Kent State University, and EVMS
• MMPI-2-RF used as a template, e.g., RC, Higher-Order, and Specific Problems Scales
• Norms based on MMPI-A normative sample• Clinical samples from several settings, with
data sets used separately for scale development and validation
• Reduced length from 478 to 241 items
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Salient differences between the MMPI-A and the MMPI-A-RF
Variable MMPI-A MMPI-A-RF
Year of Publication 1992 2016
Primary Influence MMPI-2 MMPI-2-RF
Number of Items 478 241
Scale Structure Extensive item overlap across scales
Non-overlapping items within
hierarchical scale structure
Norms Gender Specific Non-gendered
T-score criterion for
clinical elevationT ≥ 65 T ≥ 60
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11 studies including non-clinical samples (1995-2012)
MMPI-A Scales
Validity Clinical
L F K Hs D Hy Pd Mf Pa Pt Sc Ma Si
Mean 51.04 48.03 50.91 48.22 49.81 49.95 48.62 51.40 48.37 47.33 47.85 50.21 47.29
SD 9.27 8.43 9.13 9.92 10.22 9.36 9.06 9.91 9.35 10.46 10.07 10.64 11.61
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Test responses from 2,256 adolescents
Results support consistency in descriptive findings using contemporary sample
MMPI-A-RF Structure
• Hierarchical scale structure •3 Higher-Order scales•9 Restructured Clinical (RC) scales, •25 Specific Problems (SP) scales, •Revised versions of the Personality Psychopathology-Five (PSY-5) scales
• 48 scales •6 Validity scales •42 Substantive scales
• Critical Items and Critical Responses• 241 items
10MMPI-A-RF Training Slides, University of Minnesota Press, 2016. Copyright for all MMPI®,
MMPI®-A, MMPI-A-RF®, and MMPI-2-RF® materials are held by the Regents of the University of Minnesota.
MMPI-A-RF Validity Scales
• VRIN-r (Variable Response Inconsistency-Revised) - Random responding
• TRIN-r (True Response Inconsistency-Revised) - Fixed responding
• CRIN (Combined Response Inconsistency) - Combination of fixed and random inconsistent
responding• F-r (Infrequent Responses-Revised)
- Responses infrequent in the general population• L-r (Uncommon Virtues-Revised)
- Rarely claimed moral attributes or activities• K-r (Adjustment Validity-Revised)
- Uncommonly high level of psychological adjustment 11
Higher-Order (H-O) Scales
• EID(Emotional/Internalizing Dysfunction) - Problems associated with mood and affect
• THD (Thought Dysfunction) - Problems associated with disordered thinking
• BXD (Behavioral/Externalizing Dysfunction) - Problems associated with under-controlled behavior
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Restructured Clinical (RC) Scales
• RCd (Demoralization) - General unhappiness and dissatisfaction• RC1 (Somatic Complaints) - Diffuse physical health complaints• RC2 (Low Positive Emotions) - A distinctive, core vulnerability
factor in depression• RC3 (Cynicism) - Non-self-referential beliefs that others are bad
and not to be trusted• RC4 (Antisocial Behavior) - Rule breaking and irresponsible
behavior• RC6 (Ideas of Persecution) - Self-referential beliefs that others
pose a threat• RC7 (Dysfunctional Negative Emotions) - Maladaptive anxiety,
anger, and irritability• RC8 (Aberrant Experiences) - Unusual perceptions or thoughts
associated with psychosis• RC9 (Hypomanic Activation) - Over-activation, aggression,
impulsivity, and grandiosity, uncontrolled behavior13
Alpha CoefficientsScale Boys Girls Combined
RCD (18 items) .83 .87 .86
RC1 (23 items) .72 .80 .76
RC2 (10 items) .65 .61 .63
RC3 (9 items) .62 .59 .61
RC4 (20 items)
.71 .73 .71
RC6 (9 items) .63 .66 .64RC7 (11 items) .59 .68 .64
RC8 (8 items) .69 .64 .67RC9 (8 items) .47 .54 .50
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Demoralization (RCd)Test Response
T score < 40 Reports a higher-than-average level of life morale and life satisfaction T score 60-79 Reports feeling sad and dissatisfied with his or her current life circumstancesT score ≥ 80 Reports feelings of depression, social isolation, low self-confidence, and
helplessness
Empirical CorrelatesMay experience suicidal ideationFeels life is a strainFeels sadReports feeling “depressed”Feels anxiousHas low self-esteemHas problems with attention and concentrationReports feeling ineffective in dealing with problemsComplains of low energy and fatigue
Diagnostic ConsiderationsEvaluate for depression-related disorder
Treatment ConsiderationsEvaluate risk for self-harm (if suicide items are endorsed or HLP ≥ 60) 15
Somatic/Cognitive Scales
• MLS (Malaise)- Overall sense of physical debilitation, poor health
• GIC (Gastrointestinal Complaints) - Nausea, recurring upset stomach, & poor appetite
• HPC (Head Pain Complaints) - Head and neck pain
• NUC (Neurological Complaints) - Dizziness, weakness, paralysis, loss of balance, etc.
• COG (Cognitive Complaints) - Memory problems, difficulties concentrating
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Internalizing Scales• HLP (Helplessness/Hopelessness)
- Belief that goals cannot be reached or problems solved
• SFD (Self-Doubt) - Lack of self-confidence, feelings of uselessness
• NFC (Inefficacy) - Belief that one is indecisive and inefficacious
• OCS (Obsessions/Compulsions) - Varied obsessional and compulsive behaviors
• STW (Stress/Worry) - Preoccupation with disappointments, difficulty with time pressure
• AXY (Anxiety) - Pervasive anxiety, frights, frequent nightmares
• ANP (Anger Proneness) - Easily angered, impatient with others
• BRF (Behavior-Restricting Fears) - Fears that significantly inhibit normal behavior
• SPF (Specific Fears) Multiple specific fears
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Externalizing Scales• NSA (Negative School Attitudes)
- Negative attitudes and beliefs about school
• ASA (Antisocial Attitudes) - Various anti-social beliefs and attitudes
• CNP (Conduct Problems) - Difficulties at school and at home, stealing
• SUB (Substance Abuse) - Current and past misuse of alcohol and drugs
• AGG (Aggression) - Physically aggressive, violent behavior
• NPI (Negative Peer Influence) - Affiliation with negative peer group
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Interpersonal Scales
• FML (Family Problems) - Conflictual family relationships
• IPP (Interpersonal Passivity) - Being unassertive and submissive
• SAV (Social Avoidance) - Avoiding or not enjoying social events
• SHY (Shyness) - Feeling uncomfortable and anxious around others
• DSF (Disaffiliativeness) - Disliking people and being around them
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Personality Psychopathology Five (PSY-5) Scales
• AGGR-r (Aggressiveness-Revised) - Instrumental, goal-directed aggression
• PSYC-r (Psychoticism-Revised) - Disconnection from reality
• DISC-r (Disconstraint-Revised) - Under-controlled behavior
• NEGE-r (Negative Emotionality/Neuroticism-Revised) - Anxiety, insecurity, worry, and fear
• INTR-r (Introversion/Low Positive Emotionality-Revised) - Social disengagement and anhedonia
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Forbey and Ben-Porath MMPI-A-RF Critical Items
Content Area # of ItemAggression 2Anxiety 4Cognitive Problems 2Conduct Problems 7Depression/Suicidal Ideation 7Eating Problems 2Family Problems 2Hallucinatory Experiences 3Paranoid Ideation 6School Problems 4Self-Denigration 2Somatic Complaints 6Substance Use/Abuse 5Unusual Thinking 1
Total Items 5321
MMPI-A-RF InterpretationTopic MMPI-A-RF Source
I. Protocol Validitya. Content Non-Responsiveness CNS, VRIN-r, TRIN-r, CRINb. Over-Reporting F-rc. Under-Reporting L-r, K-r
II. Substantive Scale Interpretationa. Somatic/Cognitive Dysfunction RC1, MLS, GIC, HPC< NUC, COGb. Emotional Dysfunction 1. EID
2. RCd, HLP, SFD, NFC3. RC2, INTR-r4. RC7, STW, AXY, ANP, BRF, SPF, OCS, NEGE-r
c. Thought Dysfunction 1. THD2. RC63. RC84. PSYC-r
d. Behavioral Dysfunction 1. BXD2. RC4, NSA, ASA, CNP, SUB, NPI3. RC9, AGG4. AGGR-r, DISC-r
e. Interpersonal Dysfunction 1. FML2. RC33. IPP4. SAV5. SHY6. DSF
f. Diagnostic Considerations Most Substantive Scalesg. Treatment Considerations All Substantive Scales
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MMPI-A-RF Profiles
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Comprehensive Behavior Management Solution
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Behavioral and Emotional
Screening System(BESS)
BASC‐3 Rating Scales
‐ Teacher Rating Scales (TRS)
‐ Parent Rating Scales (PRS)‐ Self‐Report of Personality (SRP)
Parenting Relationship Questionnaire
(PRQ)
Structured Developmental
History(SDH)
Student ObservationSystem(SOS)
Behavior Intervention Guide
Behavioral and Emotional
Skill‐BuildingGuide
Flex Monitor
Student ObservationSystem(SOS)
Parent Tip Sheets
Intervention Report
Documentation Checklist
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BASC-3 Components
• BASC-3 Teacher Rating Scales (TRS), Parent Rating Scales (PRS), and Self-Report of Personality (SRP)
• BASC-3 Student Observation System• BASC-3 Structured Developmental History• BASC-3 Parenting Relationship Questionnaire—all ages• BASC-3 Behavioral and Emotional Screening System (Teacher, Parent,
Student Forms)• BASC-3 Behavior Intervention Guide• Behavioral and Emotional Skill-Building Guide, part of the BASC-3 family• BASC-3 Flex Monitor (Teacher, Parent, and Student Forms)
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RATING SCALES (PRS, TRS, SRP)
Parent Rating ScalePreschool, Child, AdolescentAll available in Spanish as well as English
Teacher Rating ScalePreschool, Child, Adolescent
Self-report of PersonalityInterview, Child, Adolescent, CollegeChild & Adolescent also in Spanish
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Systematic Approach to Interpretation
1. Interpret Validity Indexes
2. Interpret Composite Scores
3. Interpret Scale Scores
4. Interpret Items
Copyright © 2016 Pearson Education, Inc. or its affiliates. All rights reserved.
Rating Scales: Interpretation principles Most raters are truthful. Person with the most deviant ratings is the person
who knows the child best Referral Bias: (schools) Teacher ratings are going to be the most deviant Parents will identify smaller number of problems Child will identify none
Have a conversation with the raters for qualitative information
Embrace disagreeable ratings because they enhance your qualitative perspective
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Q-global And The BASC-3
Q-global is a secure, online, web-based system used to administer and score the TRS, PRS, SRP, SDH, SOS, and PRQ forms.
Administration Options OSA (on screen administration ROSA (remote on screen
administration Sends an email to the respondent
containing a web link needed to complete the form
Then you will receive an email indicating the form is complete
Paper form & manual response entry
BASC-3 Q-Global Report Features• Validity Indexes• Clinical and Adaptive Scales• Content Scales• Clinical Probability Indexes• Executive Functioning Indexes• Validity Index Item Lists• Clinical And Adaptive Scale Narratives• Content Scale Narratives• Target Behaviors For Intervention• Critical Items• DSM-5 Diagnostic Considerations• Items By Scale• Item Responses
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Additional ReportsMulti-rater Report
Allows you to compare results from the BASC-3 PRS and TRS across multiple raters
Progress ReportAllows you to compare the same rater across multiple time points
Integrated Summary ReportCombines results from individual components including the SRP.
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FREE!BASC-3 Multirater Report
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Copyright © 2016 Pearson Education, Inc. or its affiliates. All rights reserved.
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Copyright © 2016 Pearson Education, Inc. or its affiliates. All rights reserved
34Copyright © 2016 Pearson Education, Inc. or its affiliates. All rights reserved.
BASC-3 Integrated Report
Up to 5 BASC-3 TRS, PRS, & SRP recordsIncludes:
Validity Index Summary Table* Scaled score Summary Table*Shared Items Comparison section**
Administration selections must be from same report level (Preschool, Child, Adol)
Only one SRP can be included; no COLAdministration selections must be in “Report
Generated” status* Always prints on report** Only prints when significant discrepancies exist in responses
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Q-Global - Intervention Report
Adds Intervention Report section to BASC-3 Report
Intervention Report section content:•Table with Primary & Secondary improvement areas and Adaptive Strengths
•Intervention Summary Section•Walks through some different Intervention Options, using information from Intervention Guide
•Does not cover every Intervention suggested in Guide in every report
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BASC-3 Behavior Intervention GuideKimberly Vannest, Cecil Reynolds, Randy Kamphaus
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• Comprehensive set of empirically-based interventions for a variety of behavioral and emotional problems
• Organized around scales included on the BASC-3 TRS, PRS, and SRP forms
• Intervention Components include:• Behavior Intervention Guide (Paper and Digital)• Parent Tip Sheets• Documentation Checklist• Intervention Summary software report for TRS, PRS, and
SRP
BASC-3 Behavior Intervention Guide• Aggression
• Conduct
• Hyperactivity
• Attention
• Academic Problems
• Anxiety
• Depression
• Somatization
• Adaptability
• Functional Communication Problem
• Social Skills Problems
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78 – Interventions across eleven of the most common problems of children and youth.
Step by step procedures (prep – implement-evaluate)
Considerations for practice and troubleshooting.
Elementary and Secondary illustrations.
Annotated bibliographies of research studies.
What is in the Guide?
Each of the 78 Interventions: THE BASICS - Descriptions of essential concepts,
about resources and skills needed The “PIE” approachPREP – what do I need to get started or use this intervention (training? Materials? Skill sets?)IMPLEMENT – step by step directions, examples for elementary and secondary grades, practical suggestions from actual implementers with studentsEVALUATE – what do I need to check on to see if this worked? What do I trouble shoot if I’m not sure I got the results I wanted
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Parent Tip Sheets
Supports professional practice by enhancing communication skills.
Provides support and partnership between home and school.
Includes:oBrief explanation of the nature and cause of problem behavioroSuggestions for working with their childoThree or four corresponding, evidence based strategies appropriate for a home setting.oChart to track and monitor progressoWebsites and additional resources for parents and families
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Recent research summarized in the APA clinician’s digest…
Including an extensive meta-analysis, demonstrates that when parents are included as part of the treatment/intervention process for children and adolescents with EBDs, treatment effects improve between .5 and 1.0 SDs.
BASC-3 Parent Tip SheetsAggressionConduct ProblemsAcademic ProblemsAdaptabilityAnxietyAttention ProblemsDepressionFunctional
CommunicationHyperactivitySomatizationLeadership/Social Skills
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Tools For Partnership
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We must monitor Treatment Fidelity or it will not occur
Along with the Intervention Guides, the Documentation Checklist is available to document and assess treatment fidelity in for individual cases.
BASC-3 Flex Monitor: What is it?
A psychometrically sound means of developing user- customized behavior rating scales and self-report of personality forms tailored to the needs of:
1) the individual practitioner2) an individual case3) an individual program need
Reliability data and standardized scores are then obtainable for each unique form developed for your unique need.
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BASC-3 Flex Monitor
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• Can be used to monitor behavioral and emotional functioning over a desired period of time
• Users will have the ability to:• Choose an existing monitoring form (ADHD, Ext.,
Int., Adaptive)• Create a form using an item bank• Choose a rater (teacher, parent, or student)• Administer digital or paper forms• Set up recurring administrations over a specified
time period• Generate monitoring reports to evaluate change
over time
BASC-3 Flex Monitor – How does it work?
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• For custom forms, a user will be able to choose from our item pool and start “building” a form
• Items can be filtered/searched• When building the form, the
user will be able to compute the estimated reliability of the form, based on the standardization data sample
• Adjustments can be made to the form based on the user’s needs
BASC-3 Flex Monitor – How will it work?
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• Forms can be saved, and shared with other users within a school or hierarchy
• Reports will include T scores that are generated based on the TRS/PRS/SRP standardization samples
• This enables comparisons with a normative population, describing the extremeness of scores
• Intra-individual comparisons (i.e., comparing time 1 vs. time 2, etc.) are also provided
BASC-3 Flex Monitor –Why choose the Flex Monitor?
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• Based on the authors’ desires to move the field toward better practice
• In every other area of assessment, psychometric properties of the instruments being used are paramount; however, we tend to ignore it when using monitoring tools
• The BASC-3 Flex Monitor will be a unique offering that is exclusive to the BASC-3
• 15 year old boy
• Mother died in auto accident when he was 6 years
• Separation anxiety regarding father
• Received time-limited therapy
• As Stephen grew older, he became increasingly fearful and anxious, socially isolated, withdrawn
• Target of bullying
• Father concerned about refusal to participate in after school activities
• Referred for outpatient evaluation & treatment53
Stephen – Psychiatric Outpatient
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Stephen’s SRP
MOMENTUM NSM15
T Score Percentile Rank
School Problems 39 14
Internalizing Problems 70** 95
Inattention/Hyperactivity 50 56
Emotional Symptoms Index 81** 99
Personal Adjustment 23** 1
F Index Response Pattern
Consistency L Index V Index
Acceptable Acceptable Acceptable Acceptable Acceptable
Stephen’sSRP
T Score Percentile Rank
Attitude to School 43 28
Attitude to Teachers 48 47
Sensation Seeking 35 5
Atypicality 50 63
Locus of Control 49 55
Social Stress 80** 99
Anxiety 65* 90
Depression 89** 99
Sense of Inadequacy 71* 96
Somatization 63* 87
Attention Problems 64* 90
Hyperactivity 36 2
Relations with Parents 45 27
Interpersonal Relations 10** 1Self-Esteem 27* 4
Self-Reliance 33* 5
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Stephen’s SRPContent Scales
T Score Percentile Rank
Test Anxiety 41 19
Anger Control 46 39
Mania 36 5
Ego Strength 14* 1
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DSM-5™ DIAGNOSTIC CRITERIA
Listed below are DSM-5 Diagnostic Criteria based on the ratings obtained from on the SRP-A rating form. Each section first presents a list of symptoms of the disorder, along with SRP-A items that correspond to these symptoms. Then related DSM-5 criteria and codes are presented. While information from SRP-A items will likely be helpful for making a diagnosis, clinicians are strongly encouraged to use additional information that is gathered outside of the BASC-3 SRP-A form (e.g., observations of behavior, clinical interviews) when making a formal diagnosis. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Copyright © 2013).
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BASC-3 SRP-A INTERVENTION RECOMMENDATIONS
Primary Improvement Areas
Secondary Improvement
Areas
Adaptive Skill Strengths
- Depression- Interpersonal Relations (Social Skills)- Self-Esteem- Sense of Inadequacy- Social Stress
- Self-Reliance- Anxiety- Attention Problems- Somatization
- None
Stephen's scores on Interpersonal Relations (Social Skills) and Depression fall in the clinically significant range and probably should be considered among the first behavioral issues to resolve. His score on Anxiety is also elevated and may warrant targeted interventions and/or further monitoring to ensure it doesn't worsen.
Note that Stephen has scores on Social Stress, Self-Esteem, Sense of Inadequacy, Self-Reliance, Attention Problems, and Somatization that are areas of concern. Interventions for these areas are not provided in this report. However, these areas may require additional follow up.
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Primary Improvement Area:
Interpersonal Relations (Social Skills)
The essential elements of Social Skills Training include the following:
1. Identify the target social skills to develop.2. Teach the skills and talk about why each is useful or important.3. Model the skills through active demonstration.4. Help the child practice the skills in a controlled environment while receiving feedback.5. Assist the child in generalizing the skills by practicing them in new environments.
The procedural steps for incorporating social skills training into the treatment of social skills deficits are summarized below. See the BASC-3 Behavior Intervention Guide for a detailed discussion of this topic.
Primary Improvement Area:
Depression
There are two groups of intervention strategies that have been shown to effectively remediate problems associated with depression, including: Cognitive-Behavioral Therapy (which typically includes one or more of the
strategies below) Psychoeducation Problem-Solving Skills Training Cognitive Restructuring Pleasant-Activity Planning Relaxation Training Self-Management Training Family Involvement
Interpersonal Psychotherapy
A detailed summary of Relaxation Training and Problem-Solving Skills Training intervention is provided below. See the BASC-3 Behavior Intervention Guide for additional details about these interventions, along with the other intervention strategies listed above.
Depression Problems Intervention Option 1:
Relaxation TrainingRelaxation training teaches children to relax by monitoring muscle tension created by stressful situations and events. Tension-related physical discomfort can exacerbate common depressive symptoms and cause a child to feel even worse about him- or herself and the situation. Improvements in the child's physical well-being can influence his or her thoughts and emotions and lead to a reduction in depressive symptomatology.
The goal of relaxation training is to help the child learn to use physiological changes in his or her body to relieve depressive symptoms.
The essential elements of Relaxation Training include the following:1. Identify emotional triggers and their corresponding physical symptoms.2. Teach the child the selected relaxation techniques.
The procedural steps for incorporating Relaxation Training into the treatment of depression are summarized below. See the BASC-3 Behavior Intervention Guide for a detailed discussion of this topic.
Depression Problems Intervention Option 2:
Problem- Solving Skills Training Problem solving enables a child to identify negative thinking that occurs in a specific situation, recognize how those thoughts can lead to depression, and replace those thoughts and subsequent feelings with healthier ones.
The goal of problem-solving skills training is to help a child to view situational depression (caused by a lack of positive reinforcement) as a dilemma to be resolved rather than as a hopeless situation or an incurable disease.
The essential elements of Problem-Solving Training include the following:1. Define the problem (e.g., thinking patterns, loss of appetite, decreased interest, agitation) as actionable.2. Generate potential actions or solutions.3. Evaluate these options.4. Select the option that is the best fit and try it out.5. Evaluate and revise as desired.
The procedural steps for incorporating problem-solving skills training into the treatment of depression are summarized below. See the BASC-3 Behavior Intervention Guide for a detailed discussion of this topic.
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Problem-Solving Skills TrainingImplemented for target behaviorsWorryingFeeling anxiousFeeling lonely
Stephen was seen for weekly therapy sessions.
Stephen completed the BASC-3 Standard Flex Self, Adolescent, Internalizing (10 items) once per month
BASC-3 Flex Monitor, Standard, internalizing
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Flex Monitor Progress Report
QUESTIONS?
Anise Flowers, Ph.D.Assessment ConsultantSouth Texas
936-321-7663 [email protected]