PSY614
Bullock
p. 1 of 4
Format for Mock Assessment Report
Mock Assessment Report
PSY 614
Name: (client’s name) Examiner: (your name and degree)
Date of Birth: Supervisor: Emily E. Bullock, Ph.D.
Age: Date(s) of Testing:
Date of Report:
Reason for Referral
You will be provided a brief reason for referral with your provided PAI protocol. You should use this provided reason for referral to expand upon and complete the requirements of this section.
This section includes a brief description of the examinee and a summary of the referral source’s questions regarding the examinee. Since the reason for referral should guide you in selecting appropriate tests, stating it here helps the reader understand why you selected the tests you chose. The reason for referral might be a medical problem, problems with employment functioning, emotional/mental problems, etc. In any case, include:
The name and position of the referral source,
Why the referral source wants this person to be tested,
Specific questions the referral source has about the examinee, and
A brief summary of any behaviors or symptoms that led to the referral.
You also want to include something about the examinee’s understanding of his/her problems (i.e., why they think they are here for testing).
For example:
Ms. Doe, a 26-year-old single white female majoring in business at the University of Southern Mississippi, was referred for a psychological evaluation by Dr. T of the University Counseling Center. Dr. T. requested a diagnostic evaluation to help clarify whether Ms. Doe was suffering from a mood disorder and to assist in treatment planning.
Ms. Doe reported that she is currently in her 3rd year of school and plans to graduate in December of next year. She stated that she is currently living in Hattiesburg with her boyfriend. She listed her gross annual income as $9,000, adding that she has a difficult time living on this amount. In terms of her physical appearance, Ms. Doe was well-groomed and dressed in a manner appropriate to the setting. She appeared somewhat younger than her chronological age.
Ms. Doe indicated that she had been referred for testing because, “My doctor thinks I might be depressed.” She stated that she has been feeling “down” lately and has even contemplated suicide.
Relevant History
For this assignment, you do not have the information to appropriately complete this important section of a full psychological assessment report. This competency will be assessed in your Mock Interview assignment. Leave the heading for this section in your report and make a statement regarding that insufficient information is available to address relevant history.
The information in this section may come from clinical interview(s), collateral sources, records, etc. Acknowledge the sources of the information and provide relevant dates. The guiding principle here is to include what is relevant to answering the referral questions. This will vary considerably depending on each examinee, but this section typically starts with the history of the current problem(s). Beyond that certain areas are usually addressed for all examinees.
For adult clients, the following areas should be addressed:
Traumatic events, violence, environmental concerns (e.g., history of child abuse)
Social history, including information about family functioning, divorce, stepfamily, peer
relationships, dating, marriages, children, etc.
Educational history, including highest level of education completed, grades if known,
disciplinary problems, etc.
Employment history, including type and number of jobs held, current functioning, etc.
Legal history, including whether they have ever been arrested, convicted, sued, etc.
Substance use/abuse, including amount and frequency of alcohol consumption, use of
illicit and prescription drugs, etc.
Medical history, including serious illnesses, hospitalizations, physical complaints, etc.
Psychiatric history, including specific mental illnesses they may have been diagnosed
with in the past, psychiatric medications they may have received, psychiatric
hospitalizations, therapy, etc.
For “child” clients the following should be included:
Birth history
Developmental milestones (walk, talk, toilet training)
Childhood illnesses
Temperament
Relationships with parents and peers
School grades, discipline problems, etc.
Family functioning
Motor coordination
Evaluation Procedures
Complete this section with regards to the PAI
In this section, you simply list each test you administered and the date on which it was administered. In addition, you would list “Clinical Interview” and mention the date (or dates) you conducted interviews. If you performed any collateral interviews (e.g., interviews with parents, friends, teachers, etc.) list them here as well. Scheduled behavioral observations would go here too (e.g., observing a hyperactive child in their classroom).
Behavioral Observations
For this assignment, you do not have the information to appropriately complete this important section of a full psychological assessment report. This competency will be assessed in your Mock Interview assignment. Leave the heading for this section in your report and make a statement regarding that the test taker was never observed by the report writer.
The goal of this section is to communicate what was observed during the assessment. Carefully describe the client’s behavior as you observed it during your interactions. You are to be as objective as possible here, presenting “the facts” as you observed them. Include direct quotes from the client in this section when appropriate. The following factors will always be relevant:
Physical appearance
Reactions to you and/or to testing
General behavior
Typical mode of relating to you
Language style
General response style
Activity level
Attitude toward self
Unusual habits, mannerisms, verbalizations (e.g., eye contact, restlessness, squirming in
chair, etc.)
Mental status from mental status examination (if appropriate)
Results
This section should constitute the majority of this assignment and is from which I will determine the majority of your grade. Use the information you learned in class to accurately write a results section for the PAI protocol you were provided.
This section should begin with a statement about how accurate you believe your results are for this client (i.e., if you have any concerns that particular test might not have been a valid indicator of a client’s true functioning). Next, report all relevant data from your testing in an organized manner. Test data are interpreted in this section.
Even though you would not typically do so, please list T-scores from the PAI in parentheses after your interpretive statements. For example, “Ms. Doe’s PAI was consistent with significant depression (DEP = 76).” This will make it easier for me to tell why you are saying what you are saying.
Diagnostic Impressions
This section generally opens with a paragraph in which you provide a rationale for the diagnostic decisions you will make and concludes with a multiaxial diagnosis. Since you have not yet been trained in the use of the DSM-IV, you do not need to include this section in your mock report for PSY 614.
Recommendations
This section should provide a list of brief recommendations in which you respond to the referral question and recommend particular steps to be taken. This is usually presented in the form of a numbered list, not a narrative. If you need additional information, you might refer the client for more testing or further evaluation by persons from other disciplines. Since you have not yet completed relevant coursework on treatment planning, you are only expected to make a reasonable attempt at this section.
Information in this section should include directions for treatment direction or appropriate referral. The recommendations should be consistent with the presenting problem and address all issues of importance in the interpretation.
Signature Lines
Add your signature and a space for your supervisor to sign in the following format:
Your name, degree Your supervisor, degree
Examiner Supervisor