Client evaluations and summaries: how person-centered planning is tainted by a diagnosis.

As a graduate student in rehabilitation counseling, I have recently enrolled in a graduate-level course entitled ‘‘Tests and Measurements.’’ Though it is a mandatory class, it is one I would have enrolled in even if it was not required because it offers an explanation of the ways and means of the mysterious and cryptic tests used to determine individuals’ profiles by examining various skills. It was during class project descriptions and a discussion of the format of an evaluation summary that I recognized a disturbing fact—a diagnosis, a history of disability, and/or reported atypical behaviors that have prompted the need for evaluation are presented at the beginning of an assessment. When I asked whether this was the norm, I was advised that indeed it was. From that moment I realized that as a counselor-in-training, I was acting in a way that was contrary to all I had been taught thus far regarding person-centered plans. I examined past evaluations of my own children, all of whom carry a diagnosis on the autism spectrum, and I realized that regardless of the psychologist or team member who was writing, all evaluation reports included the child’s diagnostic label within the first paragraph. The diagnosis was there as a blurb, written in a manner similar to the way that each child’s age had been written. It seemed as if the diagnosis were essentially as much a part of that child as the fact of his or her birth date. How could that not affect the subsequent description of skills? Where for one child a psychologist stated, ‘‘Verbal ability is above average,’’ I could not help but be impressed, because the child had high-functioning autism and had only begun speaking 2 months prior to this particular evaluation. Would I have embraced that phrase with the same relish if he were called neurotypical? The current format of an evaluation summary (i.e., including the child’s diagnosis within the first paragraph, is contrary to the goal of personcentered planning. Many researchers have examined and expounded upon the detrimental effect of ‘‘labeling’’ and the resulting stigma. In order to elicit change regarding the attitudes towards persons with disabilities, psychologists must lead by example. Although evaluation results are seen only by the treatment team members and others involved in the individual’s care, by presenting the individual’s diagnosis in the first few sentences of the evaluation, the psychologist has tainted the information that is expounded upon thereafter. Case managers and other professionals who work with large numbers of clients at one time may, due to time and budget limitations, only be able to review a client’s evaluation summary prior to a meeting or interview. The serial position effect may inadvertently influence which facts about a client are remarked upon, thereby unintentionally creating a profile of a person based on his or her disability as opposed to his or her individuality. When presenting evaluation results about the individual concerned, the placement of diagnosis might prove distracting, diverting attention from the findings discussed later in the summary. Even if the client has carried a particular diagnosis for an extended period of time, the fact that the diagnosis is so prominently placed (prior to all other results) may cause that person to perceive the diagnosis as being influential over the subsequent results. Deficits in cognition might be considered to be the result of a disability, regardless of whether the disability is actually relevant. Musalek and Scheibenbogen (2008) suggested that the therapists should factor in the influence of stigma during treatment and help clients to recognize individual strengths (not just deficiencies) in order to increase the possibility of a positive outcome for that client. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES VOLUME 49, NUMBER 3: 203–205 | JUNE 2011