Referral Letter For Mrs. Glenda Smith: A Psychometric Essay.

April 16, 2022

To: Bruce Williams, Social Worker

17 Jones St,

North Sydney, NSW, 2060 

From: <Your Name>, Psychologist

PO Box 99

North Sydney, NSW, 2060. 

Re: Referral Letter for Mrs. Glenda Smith

Dear Mr. Bruce,

This letter serves as a brief for the client, Mrs. Glenda Smith, who I have assessed under the psychiatrist's directions after being admitted to Sunrise Hospital on 30/01/2020. The letter also discusses the findings of the mental health assessment for the patient, which will be helpful when you are designing the care plan for Mrs. Glenda.

Mrs. Glenda is 65 years old female born and raised in rural Australia. She attended a local school up to year 12 and started working at 14 years. She is married to Mick (70 years) and has two children; twin boys, George and Tim. All her parents are deceased. Glenda has also retired recently.

Mrs. Glenda was referred for psychological assessment after being admitted to Sunrise Hospital under the Mental Health Act (2016). She was found wandering in the streets and looked disoriented. Furthermore, her lack of recent and immediate memory also alarmed the psychiatrist who referred her for a mental assessment test. The test was required to gauge the mental capability of Mrs. Glenda and help in deciding the best ways to offer medical care to her as provided for in the Act. Primarily, she was referred for mental assessment to establish whether a client suffers from any mental impairment that might be causing the disorientation and short-term memory loss she was experiencing.

Mrs. Glenda was subjected to a Mini Mental State Examination (MMSE) in line with the referral. Notably, the examination assesses orientation to time and place, comprehension, reading, motor skills, mood, memory, speech, thoughts, and visual perception, among other things (Larner, 2013). Assessment of these areas was necessary to check whether Mrs. Glenda had any impairments.

From the MMSE, I established that Mrs. Glenda has difficulties with time and place, comprehension, reading, and writing. Although his intellectual ability was estimated to be average, she scored 21 on the scale, which is below the cut-off score of 23. The score illustrates the possibility that Mrs. Glenda has dementia. This finding is substantiated by the areas of impairments such as disorientation, comprehension problems, disconnected thought process, and loss of immediate and recent memories.

Based on these findings, it is recommended that Mrs. Glenda be provided with any instructions in more straightforward and precise ways that would be easier for her to comprehend. Furthermore, further laboratory tests are needed to ascertain that the client has dementia. If proven, it will be recommended that she be handled with care, knowing that she has impairments in comprehending things, vision, and being disoriented. Furthermore, as a social worker, you should strive to make dressing and grooming easier for Mrs. Glenda and encourage stimulating and enjoyable activities to avoid dishevelled and further disorientation respectively (Sorrentino et al., 2021). It will be easier to craft more culturally sensitive and professional care to Mrs. Glenda while at home with this information in mind.

Psychometric Assessment Findings

I believe that the information presented will help provide Mrs. Glenda with further assistance. If you need the entire assessment report or any further information on the client, do not hesitate to reach out to me at any time.

Sincerely,

<Your name>

Reflection: Strengths and Limitations of Psychometric Testing

Psychometric testing is designed to measure the cognitive abilities of individuals, behaviour, or personality of an individual. From a psychological point of view, it provides the best mechanism for evaluating a person's mental status and capabilities (Spencer et al., 2013). However, the application of the test depends on what parameters of interest are needed. For a clinical setting, mental health parameters such as attention, emotional stability, organization, comprehension, mood, and thought process can be evaluated through psychometric testing. Analogous to Mrs. Glenda's case, psychometric testing is helpful in clinical settings to provide additional information on a patient's potential impairments. However, sometimes psychometric testing suffers different shortcomings that may reduce its efficiency in clinical applications.

Psychometric testing is among the most reliable approaches to mental health evaluations. Psychologists rely on specific psychometric tests to tell whether their clients may have impairments that point to a potential mental problem or disorder (Cohen et al., 2021). For instance, through the MMSE, Mrs. Glenda was suspected of having dementia, a disease associated with disorientation, disorganization, memory loss problems, and difficulty comprehending complex instructions (Velayudhan et al., 2014). Additionally, the self-reporting and observation techniques utilized in most psychometric tests are more accurate and convenient for clinical use. Ideally, the tests provide accurate information most of the time, allowing the other medical practitioners to focus on designing an intervention plan from an informed point of view (Warrens, 2015).

According to test theory, large samples are needed in most cases for the test to be reliable and valid (Cohen et al., 2021). However, most psychometric tests are designed as stand-alone tests that apply to one person at a time. The scoring mechanism implemented in the psychometric tests allows for evaluating a single individual at a time. Its accuracy does not depend on how many people have filled the measurement tool (Wocial & Weaver, 2012). Even in Mr. Glenda's case, the MMSE was able to assess the client accurately and provide a robust report that may point to the potential mental problem Mrs. Glenda may have.

Besides, psychometric testing allows the quantification of the psychological status of individuals. Since most scales are designed with a score that appropriately measures each response, quantifying the results becomes more possible. Furthermore, the quantification provides empirical evidence while reporting the results of an individual (Koziarska et al., 2013). Finally, psychometric tests are culturally sensitive and are designed not to interfere with an individual's beliefs. In most cases, the tests ask universal questions that cannot challenge a person's personal beliefs. Just like in the case of the MMSE used to assess Mrs. Glenda, psychometric tests are best placed to handle each individual in a culturally responsive way.

Despite psychometric testing being a popular assessment approach in clinical settings, it has several limitations. First, it is prone to response bias. Since most of them are self-reported, a dishonest person may mislead the assessor into believing what is not the absolute truth about the client (Burton & Tyson, 2015). For instance, if Mrs. Glenda intentionally failed to answer some of the questions correctly, the psychologist would have perceived that as an impairment in the area being examined. Second, psychometric tests results are challenging to comprehend without a guide to interpreting them. As with most tests, interpretation requires a person knowledgeable of the area of the instrument being used and what the scores imply. Otherwise, it would be difficult for individuals to explain the results comprehensively. Thus, psychometric tests require expertise knowledge (Carnero-Pardo, 2014). Even some general practitioners may not be able to comprehend the results if a psychologist does not break them down. Like Mrs. Glenda's case, the report must be broken down into an understandable explanation when writing a referral letter.

Recommendations for Medical Care

Lastly, some psychometric testing is poor in identifying early stages of mental problems among the patients subjected. For instance, MMSE is not efficient in detecting dementia that is still in its early stages (Devenney & Hodges, 2016). If, for example, Mrs. Glenda did not show difficulty remembering her home or was not disorganized, it would be difficult for the psychologist to conclude that Mrs. Glenda may have dementia.

In a healthcare setting, interprofessional communication is inevitable. Since a medical team is comprised of people from various fields coming together to care for one individual, passing information is crucially a sensitive matter. Essentially, sharing the outcomes and observations from professional points of view is needed for efficiency of care to be established on the patient (Matziou et al., 2014). However, there is a need to consider some critical aspects of communications through collaborations.

Clarity of information is considered in a multidisciplinary team. For example, in a clinical setting, abbreviations are used every day. However, when communicating with others, understanding others who are not well-versed with the abbreviations is considered. In most cases, communication with other professionals is in full format to avoid misinterpretation of information passing across (Foronda et al., 2016). Second, cultural humility is also a consideration implemented in the multidiscipline team. In this case, it encompasses maintaining an interpersonal stance that is mindful of other people's cultures and traditions. In a clinical setting, it helps ensure that the team members' insensitivity does not negatively impact the health of the patient or strain relationships between the healthcare providers (Prasad et al., 2016). Finally, the timeliness of information is considered when a multidisciplinary team operates as one. Providing information promptly offers the other professionals an opportunity to act promptly and swiftly hence promoting service delivery. Essentially, success is much easier to achieve when c these considerations are in place while communicating with other professionals from different fields. 

References

Burton, L., & Tyson, S. (2015). Screening for cognitive impairment after stroke: A systematic review of psychometric properties and clinical utility. Journal of Rehabilitation Medicine, 47(3), 193-203. https://doi.org/10.2340/16501977-1930

Carnero-Pardo, C. (2014). Should the Mini-Mental State Examination be retired? Neurología (English Edition), 29(8), 473-481. https://doi.org/10.1016/j.nrleng.2013.07.005

Cohen, R., Schneider, J., Tobin, R., Swerdlik, M., & Sturman, E. (2021). Psychological Testing and Assessment: An introduction to test and measurement (10th ed.). McGraw Hill.

Devenney, E., & Hodges, J. (2016). The Mini-Mental State Examination: pitfalls and limitations. Practical Neurology, 17(1), 79-80. https://doi.org/10.1136/practneurol-2016-001520

Foronda, C., MacWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: An integrative review. Nurse Education in Practice, 19, 36-40. https://doi.org/10.1016/j.nepr.2016.04.005

Koziarska, D., Wunsch, E., Milkiewicz, M., Wójcicki, M., Nowacki, P., & Milkiewicz, P. (2013). Mini-Mental State Examination in patients with hepatic encephalopathy and liver cirrhosis: a prospective, quantified electroencephalography study. BMC Gastroenterology, 13(1). https://doi.org/10.1186/1471-230x-13-107

Larner, A. (2013). Cognitive Screening Instruments. Springer London.

Matziou, V., Vlahioti, E., Perdikaris, P., Matziou, T., Megapanou, E., & Petsios, K. (2014). Physician and nursing perceptions concerning interprofessional communication and collaboration. Journal of Interprofessional Care, 28(6), 526-533. https://doi.org/10.3109/13561820.2014.934338

Prasad, S., Nair, P., Gadhvi, K., Barai, I., Danish, H., & Philip, A. (2016). Cultural humility: treating the patient, not the illness. Medical Education Online, 21(1), 30908. https://doi.org/10.3402/meo.v21.30908

Sorrentino, S. A., Remmert, L. N. & Wilk, M. J. (2021). Sorrentino's Canadian textbook for the support worker (5th Canadian ed.). Elsevier.

Spencer, R., Wendell, C., Giggey, P., Katzel, L., Lefkowitz, D., Siegel, E., & Waldstein, S. (2013). Psychometric Limitations of the Mini-Mental State Examination among Nondemented Older Adults: An Evaluation of Neurocognitive and Magnetic Resonance Imaging Correlates. Experimental Aging Research, 39(4), 382-397. https://doi.org/10.1080/0361073x.2013.808109

Velayudhan, L., Ryu, S., Raczek, M., Philpot, M., Lindesay, J., Critchfield, M., & Livingston, G. (2014). Review of brief cognitive tests for patients with suspected dementia. International Psychogeriatrics, 26(8), 1247-1262. https://doi.org/10.1017/s1041610214000416

Warrens, M. (2015). A comparison of reliability coefficients for psychometric tests that consist of two parts. Advances in Data Analysis and Classification, 10(1), 71-84. https://doi.org/10.1007/s11634-015-0198-6

Wocial, L., & Weaver, M. (2012). Development and psychometric testing of a new tool for detecting moral distress: the Moral Distress Thermometer. Journal of Advanced Nursing, 69(1), 167-174. https://doi.org/10.1111/j.1365-2648.2012.06036.x