Initial Intake/Interview and
Diagnosis
Class Presentation
Adeeb Saleh
6/11/07
Purpose of Intake
1. To gather information about the client that
would allow the agency to understand what
the underlying problem is, and to match up
the client with the appropriate treatment
and or/counselor.
2. To assess and respond to urgency of client’s
situation.
3. To familiarize client with agency and
counseling process.
Gathering Information: Who?
• The person who conducts the initial intake
process can be any staff member with the
appropriate training to do so. This is usually
an intake worker, or a counselor (MA, or BA,
depending on the agency).
• Assessor needs to be flexible, resourceful, and
experienced enough to handle such a wide
range of clients
Gathering Information: What?
• Demographic information such as: Age, Sex,
Race, Marital Status, Area of Residence or
address etc. Also called preliminary
information.
• After gathering the preliminary information
the staff member begins the initial interview
in which he/she gathers information related to
the problem at hand.
Gathering Information: What? (cont.)
• The staff member would ask about the
presenting problem, how long it has been
occurring, treatment history, family of origin,
educational history, employment history,
medical history, and any relationship issues.
• Collateral Contacts
Gathering Information: How?
• Structured or Unstructured questionairs
• The ICCF (initial client contact form) includes 11
sections that can provide data on many of the
elements that are needed to complete a client’s
chart. Sections include:
• Client description/problem description, relevant
history, mental status, Suicidal/homicidal
ideations or plan, Medical history, current
medication, allergies, substance use/abuse,
previous mental health treatment, diagnostic
impressions, recommendations
Gathering Information (cont.)
• Multimodal assessment: focuses on 7 elements
of client’s problem: (BASIC ID)
• B – Behavior
• A – Affect
• S – sensations
• I – imagery
• C – cognitions
• I – Interpersonal relationships
• D – Drug (Substance use, fitness, diet, ect.)
Things to Consider
• Length of time it takes to complete intake
assessment depends on the client, available
time, and assessor.
• The need for a positive and supportive
environment for the client is very important
(Not too friendly and not too forward)
Diagnosis: Why?
• Accurately diagnosing a client’s problems can facilitate
effective treatment planning; research indicates that
clients with some diagnoses respond better to certain
kinds of treatments than to others.
• Placing clients’ concerns in a diagnostic context can
help counselors anticipate the nature and progress of
the counseling process.
• An understanding of diagnostic terminology helps
counselors to communicate more effectively and
professionally with social workers , psychologists,
psychiatrists, etc. (Networking/Team Work).
Diagnosis: Why? (Cont.)
• If a client relocates or is transferred from one
counselor/agency to another, the use of a shared
diagnostic language can promote continuity of service.
• Diagnosis also helps agencies classify the clients they
serve in order to determine needed services,
demonstrate accountability, and justify the agencies
role in the community
• Also, counselors in private practice settings or fee-forservice agencies will have to provide diagnoses for
clients with health insurance coverage
Diagnostic Process
• In order to make an accurate diagnosis , counselors must
gather information on clients’ prsenting concerns, their
backgrounds and history, and their present situation (Intake
process).
• Using the Mental Status Exam is a good way to assess
mental and emotional disorders. The MSE focuses on
issues related to the client’s current signs/symptoms,
affect, behavior, and cognition.
• The process of reaching a diagnosis also allows the clinician
to rule out a certain diagnosis due to a predisposing
medical condition or recent substance abuse which could
have caused the presenting problem.
Diagnostic References
• The two main reference systems of diagnosis
that are widely used today are the Diagnostic
and Statistical Manual of Mental Disorders
(DSM-IV) and the Manual of International
Statistical Classification of Diseases, Injuries,
and Causes of Death (ICD-10)
• The DSM-IV provides a detailed description of
all categories of mental illness
DSM-IV
• For each disorder, the DSM-IV seeks to provide a general
description which includes:
1. A list of the disorder’s essential features and a clinical sketch.
2. A summary of characteristics usually associated with the
disorder.
3. Information on the typical onset and course of the disorder, the
impairment caused, and potential complications.
4. Information on known predisposing factors and frequency of
occurrence of the disorder.
5. Information on similar disorders to facilitate differential
diagnosis.
6. Lastly it provides diagnostic criteria for the disorder
Multiaxial System
• A full diagnosis of the client requires the use of a 5 axes system
described in the DSM-IV. Each axes signifies a different aspect of
the client’s presenting case/problem.
• Axis 1 describes the main presenting problem or psychiatric
disorder that the client is presenting
• Axis 2 generally describes any personality disorders or
developmental disorders which are generally not considered to be
mental health illnesses by insurance providers
• Axis 3 describes physical conditions or disorders as mentioned by
clients (not a medical diagnosis made by clinician)
• Axis 4 describes the severity of psychosocial stressors that may be
putting pressure or disrupting the client’s life
• Axis 5 describes the client’s current GAF score/level of functioning.
Things to Consider
• For many counselors, diagnosing a client can be
uncomfortable because the process of labeling a
client with a certain diagnosis appears to the
defeat the whole purpose of counseling.
• Keep in mind that although diagnosis is
important, as mentioned earlier, it is an imprecise
science and should be treated as such.
Counselors should seek consultation on difficult
cases and label uncertain diagnoses as
“provisional”.
Things to Consider (cont.)
• There are five causes of low reliability in the
diagnosis of mental health disorders (Seligman,
1986):
1. Subject Variance: the client may exhibit different conditions at
different times.
2. Occasion Variance: Clients are at different stages of their
conditions at different times
3. Information Variance: Different clinicians have different pieces
and sources of information about their clients
4. Observation Variance: Clinicians view and notice different pieces
of information and/or behavior as more or less important than
another.
5. Criterion Variance: Clinicians may use different criteria for
coming up with a diagnosis from the available data.
Practical Issues
• Waiting time to actually have an initial intake
appointment
• Labeling in Diagnosis
• Dealing with Different Clients: Voluntary,
involuntary, Motivated, reluctant.
• “Breaking the Ice”
Personal Experiences
• Crisis Center: Intake Counseling
• Role Playing Activity: Intake process
Annotated Bibliography
•
MacCluskie, K., & Ingersoll, R. (2001). Becoming a 21st Century Agency Counselor.
Wadsworth/Thomson learning, Belmont, CA.
The authors of the book discuss and cover relevant material about the initial
intake process, information gathering strategies, and the use of the Mental Status
Exam to gather information for the purpose of diagnosis.
•
Seligman, L. (1986). Diagnosis and Treatment Planning in Counseling. Human
Sciences Press, Inc. New York, NY.
The author of this book goes over many important aspects related to the
initial intake process, as well as the process of diagnosis. The author covers issues
related to the different types of clients that may be seen for an initial intake
interview, as well as the many different settings an initial intake interview may take
place. The author also discusses the importance of diagnosis, the use of the DSM,
and things to consider when making a solid diagnosis.
Annotated Bibliography (cont.)
•
Whittenhall, J. (2007). The medical model of mental illness: Ethical and practical
implications for diagnosis. Eye on Psi Chi, 11 (2), pp. 16-17.
The author discusses the issues and concerns related to using the
medical/categorical method of diagnosing mental illness and the reasons to why
clinicians should instead use a more dimensional approach. He explains that the
medical approach overlooks many important factors related to a client’s problems
and tends to pile all the factors into one diagnosis/disorder. A dimensional
approach looks at many aspects of the person and takes into consideration more
than just the symptoms, but the external factors as well.
Gallucci, G., Swartz, W., Florence, H. (2005). Impact of the wait for an initial
appointment on the rate of kept appointments at a mental health center.
Psychiatric Services, 56(3), pp. 344-346.
The authors of this article look into the relationship between waiting periods
to have an initial intake appointment schedule and the rate of those appointments
being kept by clients over time. The authors found that when waiting periods to
get appointments were shortened, the rate of kept appointments would increase
over time.