Recommendations for upping integrated reports

[HomeworkHelper]

Hi all,

My program has historically not done well with helping graduate students get more than the bare minimum of integrated reports. A number of people just have 2 from our assessment class unless they elected for a neuro practicum. We do have an in-house CBT clinic that might be able to integrate more testing. Are there any tests you would recommend giving that aren't too time consuming for clients (and maybe for therapists to score/interpret) that could be integrated into a standard battery for all/most clients coming in for treatment? If it helps set the tone, I'm a former student there and have a good relationship with the clinic director so I'm not hesitant to make a recommendation, but it would be good to present some options for consideration. Thoughts?

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[PsychScience]

Which domain of the integrated report are you looking to integrate into the standard intake procedure? Personality measures, intellectual tests, or cognitive/neuropsychological tests (assuming the interview/H&P is already a standard part of the process)?

 

[HomeworkHelper]

Any shorter personality inventories that would count and could assist in case conceptualization? MMPI/MCMI take some time commitment. Not sure what other domains would be helpful to give generally outside of specifically identified areas of concern.

 

[HomeworkHelper]

For an earlier practicum we did the MMPI for every case to aid in case conceptualization, but didn't give anything else so those didn't count for integrated reports. Do people have ways of getting integrated reports outside of neuropsych practica?

 

[soccercat]

The clinic at our school used the Personality Assessment Screener (a short version of the PAI which takes 45-60 minutes to do) during intakes.

 

[researchgirl]

I would imagine you could integrate a cognitive screener (MoCA?) with a shorter measure of personality (like the PAS mentioned above) into many intakes, and then end up with an integrative report.

 

[WisNeuro]

What constitutes an integrated report varies by site. At the sites I have been at, we have checked the numbers on APPIC and don't consider screeners to be adequate as to be included in an integrated report. So, we adjust those numbers for applicants to accurately reflect what we considered an integrated report.

 

[PsychScience]

For an earlier practicum we did the MMPI for every case to aid in case conceptualization, but didn't give anything else so those didn't count for integrated reports. Do people have ways of getting integrated reports outside of neuropsych practica?

More than half my integrated reports did not come from my assessment practicum, so there are definitely ways to accumulate integrated reports in other ways.

I would be wary of the symptom checklists or screener as a tool for integrated reports, however, as these are explicitly listed as insufficient for an “integrated report” by APPIC and my DCT would not have signed off on these as integrated reports for our APPIC app.

It is a time commitment, but I think the MMPI-II is a great tool and also can provide really helpful feedback to therapy patients (see Stephen Finn and Therapeutic Assessment). I’m not familiar with the MoCA, but I imagine there are brief cognitive measures that could also easily be incorporated into the assessment process (KBIT, WASI, PPVT, etc…)

 

[smalltownpsych]

I thought an integrated report would assess both cognitive and personality. We also had to make sure to have a projective measure in at least one report. I find that I can justify a WAIS and an MMPI or PAI for a lot of clients in a lot of settings so I am not sure why the opportunities are not arising. I did assessments at all of my practicums. Adolescent early intervention program, inpatient psych, VA hospital, and of course, neuropsych at an acedemic medical center.

 

[smalltownpsych]

Oh and to answer your question about less time consuming, that would be the PAI which can be quite useful if you don't have to have the strong validity measures that the MMPI has.

 

[HomeworkHelper]

Smalltownpsych, I think opportunities may be there but missed because the program doesn't seem to think integrated reports are important much at all. I didn't even know it was something important enough that it's pulled out as a separate stat in applications until the year I was applying, then I scrambled to get a couple more. Maybe they're not a big thing internships look for, but still! It's a good skill to have!

 

[PsychScience]

I thought an integrated report would assess both cognitive and personality.

I believe what qualifies for an integrated report is a little broader than that. As defined by APPIC, an integrated report is one with an interview/history along with at least two psychological tests from one or more of the following categories: personality, intellectual, cognitive, and neuropsychological. So while the definition certainly would include reports where you assess both cognition and personality, to be an integrated report, it doesn't have to include both of those domains.

 

[smalltownpsych]

I believe what qualifies for an integrated report is a little broader than that. As defined by APPIC, an integrated report is one with an interview/history along with at least two psychological tests from one or more of the following categories: personality, intellectual, cognitive, and neuropsychological. So while the definition certainly would include reports where you assess both cognition and personality, to be an integrated report, it doesn't have to include both of those domains.

I wonder if they changed the definition since I went through the process or if that was just my school's definition. That sounds much easier to fulfill then.

 

[smalltownpsych]

Smalltownpsych, I think opportunities may be there but missed because the program doesn't seem to think integrated reports are important much at all. I didn't even know it was something important enough that it's pulled out as a separate stat in applications until the year I was applying, then I scrambled to get a couple more. Maybe they're not a big thing internships look for, but still! It's a good skill to have!

I am surprised that any program would not think assessment skills are a key component of being a psychologist. On the surface of it, that sounds pretty disappointing. We were doing assessments at all of our sites. The challenge for some of my cohort was to get all of the components that our school was requiring because some sites had briefer testing only, but we were all pretty clear about what we needed to get done. I can't really advise you on how to get more because it depends on where you are working at now because you have to be working under supervision. Talking to your site supervisor about how you could make this happen would probably be your best bet, next would be to talk to your DCT.

Also, why does your status say post-doc? If that were the case, this would all be moot.

 

[HomeworkHelper]

Moot for me, not moot for my fellow, younger grad students whom I care about and want them to have better training experiences than I was able to get. My program seems to care about assessment primarily as it relates to diagnostic assessment with Scids, Hamiltons, symptom measures, etc. Excellent training in that regard. Just not much training in testing beyond MMPI and WAIS built into the program.

 

[PhDToBe]

Could you volunteer at a site, such as your departmental clinic to get a few more?

 

[psychgirl77]

In my program, the first practicum students do is usually an assessment practicum (unless they come in with a master's and already have therapy experience). This makes sure that everyone has at least some assessment experience, even if they do not go on to do a neuropsych or other assessment focused practicum. So that may be an option, or could the CBT clinic at your alma mater accept some assessment cases as well as treatment referrals?

 

[AcronymAllergy]

Of the personality-related inventories, I'd say either the PAI or MMPI-2-RF would be the way to go. Both are similar length and take similar amounts of time to administer. I don't know that anything shorter than either of those would be keeping in the spirit of an "integrated report," honestly. I mean, you could give something like the SCL-90 or Brief Symptom Inventory, but interpreting one of those isn't quite the same as interpreting an RF.

For the cognitive side of things, I personally would probably be ok with accepting a full WASI as a cognitive measure, especially if another brief cognitive instrument or two were used, but anything short of that (e.g., MoCA, SLUMS, or even Shipley) and I'd want additional testing before I'd consider it an integrated report.

As for how to work that into the clinic, it'd probably depend on what sorts of services the clinic offers, what clients are typically served, and who'd be available to supervise. Our university clinic performed psychoeducational testing as overseen by a neuropsychologist, so that's how most folks (especially the non-neuro people) got their assessment and integrated report writing experiences. Even just a handful of such lengthy batteries (ours were typically 6-8 hours) could be great for you, but you'd need someone appropriately trained to be able to supervise.

 

[Fan_of_Meehl]

Hi all,

My program has historically not done well with helping graduate students get more than the bare minimum of integrated reports. A number of people just have 2 from our assessment class unless they elected for a neuro practicum. We do have an in-house CBT clinic that might be able to integrate more testing. Are there any tests you would recommend giving that aren't too time consuming for clients (and maybe for therapists to score/interpret) that could be integrated into a standard battery for all/most clients coming in for treatment? If it helps set the tone, I'm a former student there and have a good relationship with the clinic director so I'm not hesitant to make a recommendation, but it would be good to present some options for consideration. Thoughts?

I agree with another poster that the MMPI-2-RF would be a good choice (takes 35-50mins) to include. It has a panel of validity scales that are useful in terms of gauging response biases (over/under-reporting of somatic, cognitive, and/or psychopathological symptoms). One of the troubling trends I am seeing in the VA where I work is the characterization of a screening or self-report symptom measure (such as the PTSD Checklist or the Beck Depression Inventory -- 2nd Ed.) as 'diagnostic' if the scores are above a certain cutting score. When you are dealing with a population where the base rate of over-reporting is substantial, relying solely on face-valid self-report measures of psychopathology is a huge error in my opinion.

 

[WisNeuro]

, but anything short of that (e.g., MoCA, SLUMS, or even Shipley) and I'd want additional testing before I'd consider it an integrated report.

Now if only I could convince my OT/PT section that a MoCA is not a full assessment and should not be mis/interpreted as such...

 

[AcronymAllergy]

Now if only I could convince my OT/PT section that a MoCA is not a full assessment and should not be mis/interpreted as such...

Wait, so you're saying I shouldn't interpret each and every question of the MoCA independently rather than viewing it as a measure of global cognitive status...? Poppycock!

 

[WisNeuro]

Well, if you get 0 on delayed recall, you're severely impaired. 1 recalled, moderately impaired. 2, milldy. 3-4 is average. And if you get all 5, I'm going to go ahead and say you have eidetic memory.

 

[smalltownpsych]

I'm wondering what the neuro folk think about the MoCA as a dementia screening device as compared to the DRS2 or is there a better screening device? Also what is the best predictor of DAT in your experience or according to latest research. During my neuro practicum, my supervisor said that the Faces subtest of the WMS was one of the best measures (we administered many more including WCST, BNT, Trails, CVLT, etc.). I found it interesting that they dropped that subtest from the test.

 

[WisNeuro]

The MoCA is better than the MMSE, but it really depends somewhat on the person administering it. I give it a wide confidence interval when I get scores from Neurology residents. Every time I shadow one of them administering it, they butcher it. DRS would be more sensitive by far, but it takes longer. The WCST does one thing really well, tells you how old someone is.

Faces? From what I remember of the literature, they dropped faces because it didn't correlate with any other subtests of the WMS all that well and had trouble differentiating between clinical groups.

I wouldn't rely on any one measure to diagnose DAT, gives you way too many false positives. Look for an amnestic profile across memory measures. Look for disruptions in i/ADLS. Sometimes you see the "classic" phonemic/semantic fluency split, but that is somewhat non-specific. etc etc

 

[smalltownpsych]

Thanks for the info. Sounds like I'll stick with the DRS for a screen as it is more sensitive. When I get a positive, I always refer to neuropsych and neurology for further evaluation.