Gerald D. Oster

Behavior Rating Scales

Behavior rating scales provide objective information about the observable behavior problems of preschool children, school-aged children, and teenagers. Typically completed by a child’s parent and/or teacher, these rating scales can be used for a number of purposes including clarifying whether or not a particular child has a significant behavior problem, targeting specific behaviors that require direct intervention, and assessing the impact of an intervention strategy.

Mental health providers confronting organizational change : Process, problems, and strategies

Under the influence of managed care and diminished funding, the mental health field is undergoing a major transformation. Existing mental health programs, departments, and agencies are downsizing and restructuring to develop new types of service delivery systems. Organizations must change to survive; yet necessary and adaptive change may be resisted in numerous ways by providers whose reactions and behaviors may reduce the viability of their own programs and agencies. This paper explores various characteristics and reactions of mental health care professionals as they face great stress, professional devaluation, and necessary organizational change and restructuring. Adaptive and maladaptive patterns in response to potential organizational change are explored. The role of the leader in guiding and implementing programmatic changes and in dealing with denial and resistance is highlighted. Strategies to enhance the prospects for adaptive organizational change are offered.

Educational and Perceptual Testing

When school-aged children are referred to the clinician for diagnosis, it is helpful to assess educational achievement since often academic problems are associated with a broad range of behavioral dysfunction.1 Assessing performance in school subject areas is also important in monitoring a child’s learning progress as well as in preparing school programs or interventions. Achievement tests attempt to measure the effects of a relatively standardized set of academic experiences such as that obtained in the public school system. This is in contrast to readiness tests, for example, the Metropolitan Readiness Tests, which try to predict how well prepared a child might be for school.2

The Psychological Report

The psychological report is the culmination of the referral process. Each section of the report attempts to provide the relevant data gathered during the testing session. The length, detail, and format of the psychological report vary depending on the purposes of the report, questions to be answered, complexity of the case, referral source, and, of course, the writing style of the psychologist. Ancillary information concerning the case is usually communicated either verbally or in writing by means of a cover letter to the referring clinician.

The Referral for Psychological Testing

The previous chapter has given examples illustrating the types of children seen by pediatricians and other primary health care providers who may benefit from psychological testing. Children with developmental delays, children with various learning problems in the school environment, children who do not achieve academically to the degree expected by themselves or their parents, and children who have a variety of behavioral and emotional problems may all be referred for psychological testing by primary care physicians or other health and educational providers. This chapter will discuss the referral process for psychological testing and amplify further on the coordination and professional interaction between the physician and the psychologist.

The Nature of Psychological Testing

The mother of Josh L. had suspected problems for some time; however, it was not until Josh’s fourth-grade teacher called that Mrs. L. decided to begin to look for more definite answers. Josh’s inattentiveness had increased after Christmas vacation and he had begun to act in a hostile manner toward children who had been his friends. His continuing disinterest in school was reflected in incompleted homework assignments with concomitant declining grades. Mrs. L. had discussed her concern in the past with her pediatrician, but no intervention was attempted. With these new developments, Mrs. L. and the pediatrician decided to have a private psychologist perform a thorough evaluation of Joshua. The pediatrician provided Mrs. L. with the name of a clinical child psychologist with whom he had worked in the past. She then called the psychologist, who gathered the historical antecedents of the problem from discussion with Mrs. L., thus beginning the assessment process. As a result of this conversation, it was decided that they schedule a testing session to delineate Josh’s problem areas further. The psychologist forwarded to Mr. and Mrs. L. behavioral rating scales and also sent a version of the scale to Josh’s teacher. On the day of the testing, Mr. and Mrs. L. provided additional information regarding early development, family history, and current family interaction. With this information, the psychologist was ready to introduce himself to Josh and begin the actual testing process.

The Relationship between Psychological Test Results and Medical and Neurological Problems

Psychological tests attempt to assess one or more of a variety of mental functions, including attention, memory, perception, cognitive abilities, language, mood, judgment, and thought content. Various medical and neurological problems of an acute and chronic nature may at times directly or indirectly affect these functions and thereby necessarily influence the results of psychological testing. Psychological testing in children on the other hand, although at times reflecting disordered biological functioning (here equated with “medical and neurological disorder”), is not of value in specifically diagnosing a particular medical condition, is of limited value in helping to localize the area of the brain affected by a particular lesion, and is usually superceded when precise localization is required for treatment purposes by better medical diagnostic aids such as X-ray studies. This chapter will clarify some of these relationships and provide examples of the interaction between medical problems and psychological test results.

The Child Health Professional Talks to Parents

Parents may sometimes ask physicians and other child health care providers to obtain for their children’s medical records the results of psychological tests performed in school or in a mental health clinic. At times the parents may want the clinician to explain the testing to them because they did not understand the initial interpretation when it was given or because they were too anxious to “hear” all that was said at that time. They may also want the physician to coordinate his or her services with those of the school or mental health provider.

Personality Inventories and Projective Measures

In order to study and measure personality, regardless of theoretical orientation, methods of assessing personality variables are necessary. There are today literally hundreds of different tests available for psychologists to use in assessing personality differences. The tests vary from objective self-report questionnaires to tests which emphasize personal style and expression. Techniques such as inkblots, story telling, figure drawings, play construction, reactions to humor, adjective descriptions, and role playing have all been used as means by which to gather information about an individual’s personality makeup.

The Child Health Care Professional’s Relationship to Psychological Testing

Exactly how much physicians and other child health care professionals must know about psychological testing and psychological tests depends on the role that the particular health care provider serves in providing services to children with learning and behavior problems. For physicians and other health care providers, this role has expanded considerably in the recent past.1