Clinical decision-making among professionals and paraprofessionals

Abstract

Investigated the clinical decision‐making process among three groups of mental health workers. Ss were 32 paraprofessionals, 11 social workers, and 13 clinical psychologists. Each S conducted two simulated intake interviews and decided at certain times during the procedure whether the client was (a) in need of medcation; (b) suicidal; and (c) in need of hospitalization. Results revealed that the professionals displayed no greater consensus in their decisions than did the paraprofessionals. The professionals, especially the psychologists were more confident of their decisions, but only when it was appropriate (i. e., on questions on which they had reached some consensus). The psychologists were most consistent and focused in their manner of gathering information. The majority of Ss reached their decisions early in the interviews.

Clinical Judgment in Case Conceptualization and Treatment Planning Across Mental Health Disciplines

“…Among the master's-level professionals included in this study (N = 119), mental health counselors scored higher than clinical social workers on all judgment tasks. This supports other findings that profession does influence clinical judgment (Clavelle & Turner, 1980;Falvey, 1992b;Turner & Kofoed, 1984) and suggests that certified mental health counselors are at least comparable with their clinical social work counterparts on these case management tasks.…”

“…Other findings, however, conclude that clinician demographics do not seem to significantly influence treatment decisions (Dawes, 1989;Faust et al, 1998;Rock, Bransford, Maisto, & Morey, 1987;Turner & Kofoed, 1984;Worthington & Atkinson, 1993) or that they do not usefully distinguish how clinicians think and process client data (Spengler & Strohmer, 1994;Strohmer & Spengler, 1993). For example, Clavelle and Turner (1980) compared paraprofessionals, social workers, and psychologists on judgments regarding the need for hospitalization and medication using two simulated intake interviews, finding no greater consensus in decision making among professionals than paraprofessionals. O'Donohue, Fisher, Plaud, and Curtis (1990) used a structured interview and retrospective self-report method to review three recently terminated cases of each of 25 clinicians from a community mental health center to assess their assessment methods, treatment goals and methods, finding the lack of any systematic decision process for these actions in over 90% of the 75 cases reviewed.…”

The appropriateness of confidence ratings in clinical judgment

“…Confidence ratings for psychiatric and drug treatment patients were related positively to reliability and validity (Clavelle & Turner, 1980;Garb & Shefsky, 1984). Clavelle and Turner (1980) had clinicians make treatment decisions, e.g., decide whether a client is in need of hospitalization. Clinicians were paraprofessionals, social workers, and clinical psychologists.…”

“…Experienced clinicians tended to make more appropriate confidence ratings than did inexperienced judges as long as they were given information that generally is considered to be valid. This was true for neuropsychological data (Heaton et al, 1978;Wedding, 1983), biographical data (Clavelle & Turner, 1980), information obtained from psychotherapy sessions (Brenner & Howard, 1976), and MMPI results (Moxley, 1973;Oskamp, 1962). Experienced clinicians did better than inexperienced judges when appropriateness was assessed by calculating correlations between validity and confidence (Brenner & Howard, 1976;Clavelle & Turner, 1980;Hezton et al, 1978) and when appropriateness was assessed by calculating the absolute deviation between estimated and actual levels of validity (Moxley, 1973;Oskamp, 1962;Wedding, 1983).…”

Statistical modeling of clinical intake decisions

“…Previous studies have suggested that symptomatology, mental status, diagnosis, social factors, and administrative guidelines are important cues that influence a clinician's intake decisions about patients' treatment dispositions (Babiker, 1974;Bannister, Salmon, & Leiberman, 1964;Baxter, Chodorkoff, & Underhill, 1968;Clavelle & Turner, 1980;Johnson, Klinger, & Gianetti, 1979;Jones, Kahn, & Langsley, 1965;Mendel & Rapport, 1969;Sandifer, 1972;Tischler, 1966), but these studies have been 'Our thanks to Paul Sherman, Hillel Einhorn, and Herbert Stenson for their assistance. Reprint requests should be addressed to Richard L. Greenblatt, Psychology Service ( I 16B), Veterans Administration Hospital, Hines, Illinois 60141. seriously limited by methodological problems.…”