The nature of behavioural and observational assessment

One model of assessment*1.) suggests that there are four main content areas for assessment, including cognition, affect (including verbal-subjective components of behaviour), physiological activity, and overt behaviour. Coverage of all these assessment domains is needed to provide both valid clinical formulations and evaluations of outcome. They also suggest that there are three main categories of assessment method, namely: self-report; the use of observation and instruments; and the use of technical equipment.

Neither cognitive tests, which offer precise and controlled information about intellectual functioning, nor responses to questioning during an interview, which tell us something of a person's thoughts and knowledge, necessarily describe how an individual behaves in detail on a day-to-day basis. It is important to know how a person will behave most of the time in either a clinical or 'normal' environment, particularly when designing treatment programmes. Behavioural and observational assessments possess high 'ecological validity' for this purpose, and are thus an essential complement to other forms of assessment.

This family of assessment methods may be used in the same way as other methods: for the initial assessment of a patient as part of a clinical formulation; for ongoing monitoring during the course of treatment; and as outcome measures. They may also be used in planning the care of groups of patients, when selecting patients from a larger population for a specific therapeutic programmes or regimes, and when planning services.

The adjective 'behavioural' then has two senses. It refers both to content—it is the overt behaviour of the patient that is being assessed, rather than some imputed or attributed inner faculty or trait—and also to a family of methods. Rating scales are the best established of the behavioural methods—the earliest such scales were developed in the 1910s, and some of those most frequently used now are over 30 years old.

A number of observational methods were refined alongside the clinical introduction of behaviour therapy procedures in the 1960s, and these continue to be associated with contemporary cognitive-behavioural interventions. An associated American term is 'functional assessment' (see ref. (2) for a detailed example), which describes the extent to which the skills possessed by an individual match those required to maintain an independent existence in the community. American managed-care companies may require a functional assessment to demonstrate how a provided treatment relates to the specific disabilities of a patient. Behavioural assessment procedures, as they have been developed in association with the growth of behavioural and cognitive-behavioural treatments, have a number of characteristics. They focus on current overt behaviour, and may seek to discern the controlling or maintaining variables in specific situations and for specific individuals.

Andrews et al.(3) give an excellent review of outcome measures in mental health, covering many of the most commonly used rating scales. There are a number of helpful guides to behavioural assessment, that by Bellack and Hersen (4) being one of the best established. The main members of the family of behavioural assessment procedures are given below and are summarized in BoxJ,.

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Break Free From Passive Aggression

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