Making Sense of Multiple Assessments With a Treatment-Informed Evaluation Framework

Friday, August 19, 2022

Clinician assessing a child's various cognitive abilities through testing.

Using a Treatment-Informed Evaluation Framework

This post is based on the upcoming webinar “What Am I Treating? Case Conceptualization and Treatment-Informed Evaluation (TIE) in Childhood Developmental, Behavioral, and Emotional Disorders," presented by Sam Goldstein, PhD.

Comprehensive evaluations—in which an evaluator considers information provided by different contributors, in varied settings, with multiple assessments—produce a lot of data, possibly even an overwhelming amount of data. To make sense of the volumes of information, Sam Goldstein, PhD, uses a treatment-informed framework to ensure that comprehensive evaluations lead to holistic, effective treatments.

What is treatment-informed evaluation?

Much of the time, evaluations focus on obtaining a diagnosis or determining eligibility for services—both worthy and important objectives. Treatment-informed evaluations (TIE), Goldstein says, refocus the lens so an evaluation is oriented toward planning, delivering, and monitoring treatment. The goal is to “see the world through the child’s eyes . . . focusing on what the child can see, feel, and do.”

What’s included in a TIE?

A treatment-informed evaluation must be comprehensive, so the evaluator has a clear picture of the functional life of the child at the center of the evaluation. Components often

measure brain-based skills that shape how a person thinks, learns, feels, and behaves;
build your understanding of how skills influence each other and shape a person’s response to the environment;
identify functional limitations or impairments; and
point to causes and prescribe targeted interventions.

How is a TIE conducted?

Goldstein recommends a logical, structured approach to comprehensive evaluations because children at the highest risk usually experience multiple challenges and needs.

A good starting place is a review of available records, so you can get a sense of what has already been documented. Parent and teacher checklists can give you valuable information about symptoms and their severity, as well as how the child functions and adapts day to day. Classroom observations can yield more useful data, augmented by your in-person interview with the child at the heart of the evaluation. Here’s what that process could look like step by step:

Step 1. Understand the individual’s complex history.

The documents available to you may depend on the age of the person you’re evaluating. When possible, review documents and interview parents, teachers, and health professionals to create a rich, vivid picture of

educational history,
developmental history,
occupational and pre-occupational history,
personal and medical history, and
psychiatric history.

It’s important to understand the nature of any trauma, as well as new or long-term symptoms your client is experiencing. An evaluator conducting a TIE keeps a clear appreciation of the client’s goals top of mind throughout the information-gathering process.

Step 2. Assess for impairment.

As you plan which assessments to use, Goldstein recommends that you spend some time considering these test characteristics:

the sensitivity of a test, meaning its ability to correctly identify people with a condition
the specificity of a test, meaning its ability to determine who does not have a condition
the positive predictive value of a test, or the likelihood that a person who tests positive actually has the condition
the negative predictive value of a test, or the likelihood that a person who tests negative actually does not have the condition

It’s also important to look for low-incidence conditions and disabilities such as vision and hearing impairments.

You may want to consider these assessments:

Rating Scale of Impairment™ (RSI™)

Comprehensive Executive Function Inventory™ (CEFI®)

Comprehensive Executive Function Inventory Adult™ (CEFI Adult™)

Risk Inventory and Strengths Evaluation (RISE™)

Step 3: Assess a broad spectrum of abilities and behaviors. 

In this phase of the evaluation, you’re gathering information on symptoms, skills, and abilities using valid, reliable, normative measures. These assessments can help you clarify and test some of the hypotheses you may have developed based on the history and impairments you have observed.

You may want to consider these tests:

Conners, Third Edition (Conners 3™)

Conners Comprehensive Behavior Rating Scales™ (Conners CBRS®)

Conners Early Childhood™ (Conners EC™)

Step 4: Choose narrow-spectrum tools. 

With a TIE framework, you can decide on narrow-spectrum measures based on which areas or symptoms are most disruptive to the life or well-being of your client.

Tests like these may be helpful to you as you clarify a diagnosis and plan treatments:

Autism Spectrum Rating Scales™ (ASRS®)

Autism Diagnostic Interview–Revised (ADI®-R)

Social Responsiveness Scale, Second Edition (SRS™-2)

Adaptive Behavior Assessment System, Third Edition (ABAS®-3)

Children’s Depression Inventory, Second Edition™ (CDI 2®)

Revised Children’s Manifest Anxiety Scale™, Second Edition (RCMAS™-2)

Step 5: Assess achievement and social functioning.

As you assess achievement and social functioning, the goal is to develop an understanding of the individual as a whole—not as a collection of deficits but as an individual with strengths and skills living in environments that offer varying levels of support.

Here are some of the common assessments used in this phase:

Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition (MIGDAS™-2)

Autism Diagnostic Observation Schedule, Second Edition (ADOS®-2)

Weschler Intelligence Scale for Children

Woodcock-Johnson Tests of Cognitive Abilities

Step 6: Assess resilience-building factors.

As you plan treatments, it’s important to understand the internal and external factors that may foster resilience for your client. To identify protective factors that could enable a child to weather adversity, you should assess home, school, and work environments as well as your client’s own characteristics and abilities.

Protective factors can include assets like these:

family and friends
socioeconomic factors
individual temperament
social relationships
self-esteem
faith and faith communities
self-control
sense of humor

You may find these assessments useful in this phase of evaluation:

Risk Inventory and Strengths Evaluation (RISE™)

Scale of Protective Factors (SPF)

Step 7: Assess personality.

To plan holistic treatments, Goldstein says, it’s vital to identify strengths and assets—what’s right and what’s going well. TIE is based on the principle that relieving symptoms has immediate value, while nurturing assets has long-term value as children move into adolescence and adulthood.

These assessments are often used to gain an understanding of an individual’s personality or personality style:

Personality Inventory for Children, Second Edition (PIC™-2)

Personality Inventory for Youth (PIY™)

Millon Adolescent Personality Inventory (MAPI)

Millon Pre-Adolescent Clinical Inventory (M-PACI)

Step 8: Conduct a clinical interview with the person at the center of the evaluation.

Taking the time to understand the whole individual is central to TIE. Structured or semi-structured clinical interviews can help you integrate data, refine a diagnosis, tailor interventions to match each person’s needs and goals, and build an alliance that will support positive outcomes.

What’s the key message?

Comprehensive TIEs can lead to reliable diagnoses. Perhaps more importantly, they can open a child’s world to you, leading to effective, highly individualized treatment plans.

Source

Goldstein, Sam. (2022). What Am I Treating? Case Conceptualization and Treatment-Informed Evaluation (TIE) in Childhood Developmental, Behavioral, and Emotional Disorders [PowerPoint presentation].

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