Single Session Assessment
Shawn Christopher Shea, M.D.
In the age of managed care, it has become critical that thorough assessments be performed within sixty minutes. The art of performing such assessments in a sensitive and creative fashion has become one of the most complex tasks facing contemporary clinicians. In addition it has become critical that clinicians transform this intake information into written documents that provide concise information that is also forensically sound in this age of litigation.
Outpatient clinics, drug and alcohol centers, hospitals, community mental health centers, psychiatric training programs, and counseling graduate programs have quickly come to realize the importance of providing ongoing training in this pivotal "gatekeeping" skill. It is important that such centers develop permanent training programs so that all new personnel or trainees can be rapidly brought to a level of excellence.
Such quality assurance training programs require that mentors be well skilled in the numerous educational innovations that have propelled recent state of the art training programs, including techniques such as videotape supervision, role playing, facilic analysis, and Clinician Specific Mentorship (CSM).
The following three day retreat provides the platform for the development of a sophisticated and cost-efficient training program that is designed specifically for the unique needs of the parent organization. The retreat can be provided on the shores of Lake Sunapee in New Hampshire or on-site.
Each day consists of four to five mini-workshops resulting in six hours of actual training time per day (excluding lunch and breaks). The goal of the program is the training of supervisors to develop and implement a state-of-the-art training program in Single Session Assessment. At the end of the retreat, mentors will be able to teach a variety of strategies and techniques, which allows clinicians to both rapidly and sensitively complete a full intake within sixty minutes. The emphasis is upon practical and experiential techniques that can be reliably transferred and implemented. Past retreats have also proven to be surprisingly powerful and exhilarating team building experiences for the supervisors involved.
I) Day 1
Workshop 1- Introduction to Interview Training Design
a) Design principles
b) Common design and implementation problems
c) Overcoming institutional and trainee resistance
d) Culture shifting
Workshop 2 - Practical Use of Facilic Analysis
Facilic Analysis is the study of the structuring strategies and transitions used during an interview. Schematics have been developed which allow the supervisor to quickly "map-out" the trainee's structuring movements and time utilization as they unfold. The resulting visual map is then used immediately in supervision and as a springboard for discussion in group formats. It also provides permanent record of the trainee's progress.
a) Understanding the facilic system
b) Written exercises utilizing the facilic system
c) Videotape exercises utilizing the facilic system
d) Individual and group teaching with facilicschematics.
Workshops 3 and 4 - Rapid and Sensitive Structuring I and II
a) Two workshops which follow and dissect a videotape of a sixty-minute assessment performed by the workshop leader, demonstrating a variety of structuring techniques while simultaneously cementing the group's understanding of facilic schematics. The interview includes the gathering of the following data base: I.D. and Chief Complaint, History of the Present Illness, DSM-IV differential diagnoses, Social and Developmental History, Family History, Past Psychiatric History, Drug and Alcohol History, Suicide and Violence History, Medical History and ROS, and Mental Status.
Workshop 5 - The Written Document
a) Principles of Document Design
b) Reviews key principles of writing sound documents with an emphasis upon documentation of critical liability areas such as the HPI and suicide assessment
II) Day 2
Workshop 1- Teaching Open-ended, Variable, and Closed -ended Techniques
a) Discusses the "DORS": Degree of Open-endedness Response Scale (an innovative educational language for teaching open-ended and closed-ended techniques useful in opening-up reticent clients and focusing wandering ones.)
b) Written exercises and video review of the DORS
Workshop 2 - Clinician Specific Mentorship (CSM)
a) "Diagnosis" of trainee's strengths and weaknesses utilizing videotape and facilic analysis
b) Longitudinal mentorship design
c) Self-Monitoring Forms
d) Keys to effective videotape supervision
Workshop 3 - The Art of Role-Playing
a) Pros and Cons of role-playing
b) Overcoming resistance to role-playing
c) Techniques for more powerful role-playing
Workshop 4 - New Techniques for Improving Validity
a) Introduction to techniques such as shame reversal, gentle assumption, symptom amplification, denial of the specific and others
b) Videotape workshop demonstrating the above
Workshop 5 - Advanced Strategies for Personality Assessment
a) Practical interview strategies for arriving at an Axis II diagnosis using DSM IV
b) Videotape workshop demonstrating the above
III) Day 3
Workshop 1- The Art of Macrotraining I
a) Macrotraining was developed by Shea and associates at Western Psychiatric Institute Clinic. It is a sophisticated method of utilizing role-playing, reading, and videotape for teaching strategies for complex interview tasks such as suicide and homicide assessment, drug alcohol histories, and incest and abuse
Workshop 2 - The Art of Macrotraining II
a) Macrotraining actually demonstrated by the workshop leader using one of the group participants. This macrotraining exercise demonstrates the CASE (Chronologic Assessment of Suicide Events) approach to suicide assessment, an innovative interview strategy for ensuring quality assurance in suicide assessment.
Workshop 3 - Designing Mentor Group Meetings
a) Discusses and models a prototype mentor group meeting in which mentors provide feedback and support concerning their supervision efforts.
b) Uses a psychiatric resident's videotape as a spring-board for discussion of developing individual learning programs with mentor groups
Workshop 4 - Program Design
a) Focuses upon developing a feasible training program at the client's institute or clinic, acknowledging practical limitations such as supervisor availability, financial limitations and time constraints.
Workshop 5 - Wrap-up