By: SOPHIA F. DZIEGIELEWSKI
The International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders reflect the official nomenclature used in mental health and other
health-related facilities in the United States.
Diagnostic assessment systems such as the DSM, the ICD, and the PIE are three descriptive
(categorical) classification schemes that cross all theoretical orientations.
The concept of understanding mental disorders;
their taxonomical categorization; the formulation and completion of a
diagnosis, assessment, or the diagnostic assessment; and their
definitions and meanings are embedded in the history of the DSM. Exactly what constitutes diagnosis and what constitutes
assessment remains blurred and overlapping, with the words used
interchangeably yet remaining distinct and interrelated. For
all professional practitioners, compelling demands and pressures related to practice reimbursement clearly emphasize the need for coordination in providing
mental health care and subsequent intervention. Despite the differences among the disciplines, all mental health professionals need to be familiar with and able to apply the criteria used in the DSM diagnosis.
Because of the increasing demands related to evidence-based
practice to achieve outcomes to assess quality, the effectiveness of service delivery, and the collection of data, numerous diagnosis and assessment measurements are currently
available. Many are structured in unique categories
and classification schemes. Whether this categorical approach used in the DSM is replaced
by a dimensional one in the DSM-5 still remains to be seen (Helzer et al., 2008).
Utilizing the current system, this text
demonstrates the application of these classification schemes and describes
how assessment, treatment planning, and intervention become intertwined (Dziegielewski, 2008). Because assessment and treatment are based primarily on the practitioner’s clinical judgment and interpretation, a thorough grounding in these classification systems will
help the practitioner make relevant, useful, and
ethically sound evaluations of clients.
Practitioners need to remain familiar and update
their knowledge with some of the major formal methods of diagnosis and assessment, especially the ones most commonly used for billing of mental health services. The changes made over time and efforts toward betterment within the criteria outlined in the DSM have moved
it toward becoming the best diagnostic tool possible. All mental health practitioners, regardless of discipline, can benefit by utilizing this information to systematically interpret and
assist clients in understanding what the results of
the diagnostic assessment mean and how best to select empirically sound and ethically wise modes of practice intervention.
No matter whether we call what professional
practitioners do assessment, diagnosis, or a combination resulting in the diagnostic assessment,
the function remains a critical part of the helping
process. Diagnosis and assessment is the
critical first step to formulating the plan for intervention (Dziegielewski et al., 2002; Dziegielewski & Leon, 2001). The plan for intervention sets the entire tone and circumstances of
the professional helping process. As Dziegielewski (2013) has stated, based on the
general context of reimbursement or fee for service, is it wise for all professionals to continue
to struggle to differentiate diagnosis and assessment?
Unfortunately, with the shift in mental health
care to market-based services, practice and methods
have evolved to reflect specialization, integration, and cost-effectiveness as
part and parcel of service delivery. Now the
question that arises is: Who is eligible to make
a diagnosis or an assessment? Professionals are
lobbying, and professional licensures reflect this transition and can
help to provide public accountability.
Today, the role of the practitioner is twofold:
(1) Ensure that high-quality service is provided
to the client and
(2) Provide the client access
and opportunity to see that his or her health
and mental health needs are addressed.
Neither of these tasks is easy or popular. Amid this
turbulence, the role and necessity of the services that the practitioner provides in assessment
and intervention remain clear. All helping professionals must know and utilize the tools of
diagnostic assessment and demonstrate competence in
properly completing diagnostic assessment—the first step in the treatment hierarchy.
To achieve this, it is crucial that health and mental
health professionals have comprehensive training in this area to meet current requirements
and service needs in an environment filled with limitations
and shortages. The question remains: How can we
best help the clients we serve?
References
SOPHIA F. DZIEGIELEWSK, 2015, DSM-5TM in Action, by John Wiley & Sons,
Inc.
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