Psychological Assessment Services

From Dr. Jochem

Every course of counseling is based upon an evaluation of the presenting problem, how it impacts upon the individual, couple or family and the history of the problem. Evaluation is a fundamental component of general mental health practice.

Sometimes, however, there is an indication for a specialized psychological assessment, usually to guide treatment, educational, medical or work-related decisions. I have obtained training and clinical experience in the provision of specialized evaluations, as described below.

Threat Assessment Consultation

When I completed my training as a clinical psychologist I didn't anticipate that I would later develop expertise in threat assessment. The development of this skill set came about through a confluence of professional experiences and has become a subspecialty area of interest in my practice over the past thirty years.

I trained and practiced in inpatient psychiatric settings, eventually becoming the administrator and chief clinician overseeing several psychiatry programs, emergency rooms and consultation-liaison services. In those settings, the clinician regularly encounters circumstances where an assessment of dangerousness is indicated. I developed a competency in threat assessment at the same time that worked as a consultant to schools in a variety of other capacities related to suicide prevention, post-traumatic care and assessment of at-risk students. Incidents of targeted school violence became an increasing concern and threat assessment in the school setting came to be a subspecialty focus of my clinical psychology practice. I have served as a consultant to many school districts under circumstances where an at-risk student or staff member requires specialized threat assessment services.

A clinician interested in threat assessment now has a variety of resources upon which to rely in developing their practice pattern. A standard of care has emerged in threat assessment which emphasizes the use of a school-based threat assessment team to manage threat circumstances. I have worked with many districts to help schools develop threat assessment capacities and have provided training in many schools and school districts. The research and training models which guide my own approach to threat assessment practice include the Comprehensive School Threat Assessment Guidelines developed by Dr. Dewey Cornell and his associates, as well as another model published by the Virginia Department of Criminal Justice Services. Both of these models emphasize the use of school-based threat assessment teams but also recommend use of outside consultation—a clinician such as myself—when indicated. I provide this specialized evaluation and consultation to at-risk students, working closely with the school threat assessment team.

Fitness-for-duty evaluations

On occasion, employers, employee assistance programs or disability management organizations may wish to determine if an employee's psychological functioning is interfering with his or her performance in the workplace. There may be concerns regarding mood, substance abuse, concentration difficulties or behavioral changes which prompt the referral. Or, in the case of police/fire personnel, there may have been a work-related traumatic incident which prompts the need to determine if the employee is cleared to return to their customary duties.

Typically, the components of fitness-for-duty evaluations include the following:

• Consultation with the referring organization to identify the issues of concern and goals of the evaluation process.
• Diagnostic clinical interviews with the employee, often including collateral contact with the employee's spouse or other family members. The evaluation sessions include a comprehensive assessment of the presenting problems of concern, review past history and the provision of an extended mental status examination.
• Consultation with treating clinicians already involved in the patient's care.
• Psychological testing may be utilized as part of the evaluation process.
• An opinion regarding fitness to return to the workplace is provided, along with recommendations for accommodations or further treatment needs.

Specialized evaluations of children and adolescents to determine fitness for inclusion in the school setting

The exclusion of a student from school attendance pending a mental health evaluation is a relatively rare event. However, under certain circumstances school administrators may require that a student have an independent mental health assessment—a school fitness evaluation—before the student is cleared to participate in the school setting. Typically, the circumstances prompting such a referral relate to behavioral changes or concerns over an apparent deterioration in functioning or, perhaps, concerns over the student's possible risk of dangerousness to self or others.

A school fitness evaluation is appropriate for students who are not deemed to require an urgent evaluation in an emergency room setting, but whose capacity to safely function in the school environment has come into question. Typically, an event or circumstance has prompted the school to require that the student receive an evaluation before resuming school attendance.

The school fitness evaluation shares many components with adult fitness-for-duty assessments and typically includes the following components:

• Consultation with the referring school to identify the issues of concern and goals of the evaluation process.
• Diagnostic clinical interviews with the student, always including collateral contact with the student's parent or guardian. The evaluation interviews include a comprehensive review of the presenting problems of concern, past history and the provision of an extended mental status examination.
• Consultation with treating clinicians already involved in the student's care.
• Psychological testing may be utilized as part of the evaluation process.
• An opinion regarding fitness to return to the school setting is provided, along with recommendations for accommodations or further treatment needs.

Pre-surgical consultations for persons being considered for gastric bypass procedures.

Mental health providers are frequently asked to participate in the evaluation of candidates for bariatric surgery. Many surgical weight loss programs require patients to be evaluated prior to undergoing surgical procedures. I provide assessment services which are consistent with recommendations of the American Association of Bariatric Surgery. Pre-operative evaluations for patients under consideration for bariatric surgery may include the following components:

• Consultation with program staff
• Consultation with the bariatric surgeon
• Diagnostic clinical interviews with the patient, preferably also including collateral sources of information such as the patient's spouse or other family members. Typically, the diagnostic interview will be of a semi-structured format, utilizing empirically supported evaluation measures.
• Administration of psychological testing such as the MMPI-2 or other specialized instruments designed for use with the bariatric pre-surgical population may be utilized.
• Provision of a written report with findings & recommendations.

Disability evaluations

Persons applying for disability benefits under the Social Security Administration or through their employer may be required to submit to a specialized mental health evaluation. Typically, these assessments consist of the following components:

• Review of relevant records and treatment history
• Provision of diagnostic clinical interviews, often in collaboration with collateral sources of information such as the patient's spouse or other family members
• Completion of required assessment instruments or forms as required by the disability organization.

Please contact me by phone or email with any questions about these assessment services.