Review of Clinical Assessment Instruments

Evaluation of Clinical Assessment Instrument

Clinical assessment is a term used to refer to the collection of information and generating conclusions in a clinical setting. When conducting a clinical assessment, clinicians use various methods including observation, neurological tests, psychological tests, and interviews. Information collected through clinical assessment is used to draw conclusions regarding a client or patient’s problem and to identify a suitable way of helping him/her (Bridley & Daffin Jr., 2018). Clinical assessment is critical in the field of psychology and mental health as it is the premise with which these professionals obtain a clear account of a person’s condition and determine what treatment works best. As a result, there are various types of clinical assessment instruments used by clinicians and psychologists. This paper evaluates two clinical assessment instruments i.e. Caregiver-Teacher Report Form and Child Behavior Checklist (CBCL).

Caregiver-Teacher Report Form and Child Behavior Checklist (CBCL)

Caregiver-Teacher Report Form and CBCL are two clinical assessment instruments used for behavior rating. As behavioral rating scales, Caregiver-Teacher Report Form and CBCL are used for the measurement of a target behavior. According to Bridley & Daffin Jr. (2018), behavioral assessment is carried out within the realm of behavior modification. When conducting this assessment, the target behavior is the specific behavior to be changed. The target behavior can either be in excess, which implies it needs to be reduced, or deficient, which means it needs to be increased. Behavioral assessment incorporates the evaluation of three key components of behavior i.e. antecedents, behaviors, and consequences. Antecedents refer to the environmental stimuli or events that generate the behavior while behaviors refer to an individual’s thoughts, actions, and speech. On the other hand, consequences refer to the outcome or implications of that behavior.

CBCL and Caregiver-Teacher Report Form are examples of the Achenbach System of Empirically Based Assessment (ASEBA). This system has gained international interest by influencing the global standard for multi-informant evaluation of emotional, behavioral, and social function across different age groups (Kristensen, Henriksen & Bilenberg, 2010). As clinical assessment instruments under ASEBA, Caregiver-Teacher Report Form and CBCL are designed to evaluate how children and youngsters function and behave in different situations in different social settings. These clinical assessment instruments were developed following decades of research and the practical experience of Achenbach and his colleagues. Kristensen, Henriksen & Bilenberg (2010) contend that Caregiver-Teacher Report Form and CBCL have been standardized and validated in several countries worldwide.

Review of the Two Instruments

As previously indicated, Caregiver-Teacher Report Form and CBCL are some of the clinical assessment instruments under ASEBA. These instruments are similarly designed to address an empirical series of emotional, behavioral, and social function problems. They comprise 100 problem items that serve as the premise for the assessment. 99 of these problem items are closed-ended while the remaining one is open-ended. The open-ended item requests respondents to provide any additional problem items that are not listed (Kristensen, Henriksen & Bilenberg, 2010). Since the two instruments are developed under ASEBA, they have some similarities and differences.

Similarities Between Caregiver-Teacher Report Form and CBCL

One of the similarities between the Caregiver-Teacher Report Form and CBCL is their design. These two designs are similarly designed to address a wide range of empirical items relating to emotional, behavioral, and social function problems (Kristensen, Henriksen & Bilenberg, 2010; Liu, Cheng & Leung, 2011). As a result, they form the few available clinical assessment instruments targeting preschoolers. Given the similarity in their designs, Caregiver-Teacher Report Form and CBCL provide a foundational way for evaluating childhood behavior problems in different ways. Insights obtained from these two instruments are used to prevent the development of problem behaviors later in life through the identification of problem behaviors during early childhood. This implies that the similarity in design contributes to their effectiveness in the evaluation of childhood behavior problems. Caregiver-Teacher Report Form and CBCL draw their strengths in behavioral assessment from their inclusion of the wide range of problem items relating to a child’s emotional, social, and behavioral development.

The third similarity between the two clinical assessment instruments is their problem areas. As noted by Kristensen, Henriksen & Bilenberg (2010), both Caregiver-Teacher Report Form and CBCL comprise 99 closed-ended and one open-ended problem items. These problem items are specific items relating to the development and growth of preschools. This implies that the problem items have been customized to the preschoolers’ age period. Some of the common behaviors and emotions among preschoolers that are covered in the Caregiver-Teacher Report Form and CBCL include defiance, aggression, fears, hyperactivity, and social anxiety. Based on a study conducted by Liu, Cheng & Leung (2011), since the two instruments comprise similar problem items, they generate six syndromes for each measure. A factor analysis of the two clinical assessment instruments has shown their similarity in terms of the six syndromes for each measure. These syndromes are Anxious/Depressed, Emotionally Reactive, Attention Problems, Withdrawn, Aggressive Behavior, and Somatic Complaints.

According to Kristensen, Henriksen & Bilenberg (2010), these two instruments are similar in terms of their scores. The scores of each of these forms are hierarchically organized. As a result of how the test scores are ordered, Caregiver-Teacher Report Form and CBCL make it easy for clinicians to generate a formal diagnosis of behavioral, emotional, or social function problems affecting a child aged between 1.5 and 5 years. This implies that one of the strengths of these two clinical assessment instruments is the ability to generate a formal diagnosis of a child’s emotional or behavioral problems. Since the tests are standardized, the formal diagnosis obtained from the test scores is in line with the criteria in the Diagnostic and Statistical Manual for Mental Disorders (DSM). Therefore, diagnostic criteria established in Caregiver-Teacher Report Form and CBCL are consistent with DSM diagnostic categories as the scales reflect the similarity between the tests and DSM diagnostic categories. Caregiver-Teacher Report Form and CBCL scales comprise items that are consistent with those identified by psychologists and psychiatrists from different cultures resulting in alignment with DSM diagnostic categories.

Differences Between Caregiver-Teacher Report Form and CBCL

Despite the similarities between the two clinical assessment instruments, there are some differences relating to their strengths and weaknesses. According to Liu, Cheng & Leung (2011), CBCL is a better clinical assessment instrument than Caregiver-Teacher Report Form because it includes a seventh syndrome. Unlike Caregiver-Teacher Report Form, CBCL comprises a seventh syndrome known as Sleep Problems, which incorporates sleep-related problem items. In this regard, CBCL provides more data relating to a child’s emotional, behavioral, and social function because of its inclusion of a seventh syndrome. Kristensen, Henriksen & Bilenberg (2010) suggest that the inclusion of a seventh syndrome provides clinicians with more insights into a child’s behavior issues compared to Caregiver-Teacher Report Form. CBCL is seemingly a holistic approach to behavioral assessment as it promotes the measurement of sleep-related problem areas in comparison to the Caregiver-Teacher Report Form.

Achenbach & Riffle (2000) suggest the use of parallel assessment forms as a suitable measure for the behavioral assessment of preschoolers. This is primarily because of the inherent challenges in relying on only one informant to provide data. Parallel assessment forms are more suitable for behavioral assessment as they help to document consistencies and inconsistencies in how a child functions in different situations and when interacting with different people. In this regard, Caregiver-Teacher Report Form provides a better framework for behavioral assessment than CBCL. CBCL uses parents as informants while Caregiver-Teacher Report Form uses teachers, parents, and/or other caregivers as informants (Liu, Cheng & Leung, 2011). Since CBCL relies on parents as the source of information, it does not provide a holistic assessment of a child’s functioning when interacting with different people. The possibility to use Caregiver-Teacher Report Form with parents and teachers ensures it promotes parallel assessment, which is deemed as a suitable way of obtaining a holistic view of a child’s behavior and functioning. Caregiver-Teacher Report Form ensures clinicians have a better picture of a child’s behavior and functioning when used with both parents and teachers. A better picture emerges from the fact that it helps to demonstrate behavior with respect to a child’s interactions with other people.

The holistic approach adopted by Caregiver-Teacher Report Form is evident in its substitution of some of the family situation items into specific group situations. On the contrary, CBCL includes family situation items into the assessment since it is completed by a parent or an adult living with the preschooler in a family-like or home setting (Kristensen, Henriksen & Bilenberg, 2010). Caregiver-Teacher Report Form replaces these items with group situation items since the test is completed by an adult or others providing care to the child during daytime or outside the home setting. By replacing the family situation items with group situations, Caregiver-Teacher Report Form enables the clinician to obtain a holistic view of how the child behaves or acts when interacting with other people. The inclusion of group situation items is critical in the behavioral assessment process because a family-like setting is essentially a confined environment with significant influences on children’s behavior. Therefore, this setting would not be appropriate to generate insights into how a child would act or behave in other settings where he/she interacts with people other than his/her family members. However, CBCL requests additional information regarding the health of the child. Despite requesting such information, CBCL is still seemingly weaker than Caregiver-Teacher Report Form since the latter requests supplementary information that directly relates to behavioral assessment. Caregiver-Teacher Report Form requests supplementary information regarding the role of the respondent in the child’s life, kind of daycare, how well the respondent knows the child, and the context in which the child is assessed (Kristensen, Henriksen & Bilenberg, 2010).