Bridge to Health Report

Our belief is that an accurate understanding of an individual’s strengths and challenges can only be achieved through connection and relationship. Formal psychological testing is essential in understanding the nuances of someone’s functioning, but treatment recommendations should never be based solely on how someone has responded to a battery of tests. While the Bridge to Health report incorporates a broad range of tests and assessments, it only supplements the more global and holistic understanding that we gain through time spent with each Bridge House resident.

Each resident’s particular circumstances will guide the development of the test battery utilized. These tests and assessments will be chosen to help the resident and treatment team gather information quickly and will be utilized to guide the observational components of assessment as the resident begins reengaging in day-to-day activities on the Bridge House campus and in the community.

A comprehensive review of past records including mental health, medical, and academic records.

The Clinical Psychologist will conduct interviews with the resident, parents, home therapists, home psychiatrist, Bridge House therapist, Bridge House staff members, past school teachers, counselors and/or employers. Interviews with anyone outside of Bridge House personnel will be conducted only with the express written consent of the resident.

The mental status examination (MSE), is a structured way of observing and describing a resident’s psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgement. The data are collected through a combination of direct and indirect means: unstructured observation while obtaining the biographical and social information, focused questions about current symptoms, and formalized psychological tests.

These tests are used to assess “traditional” mental health issues including but not limited to depression, anxiety, identity formation, obsessive/compulsive disorder, sleep disorders, psychosis, autism spectrum issues and personality dynamics. An emphasis is on evaluating personality functioning and how it leads to emotional and behavioral issues. Data will be obtained regarding developmental and emotional age and family dynamics. These tests focus on evaluating who the resident is, and why he or she is behaving as they are. They also provide more “nontraditional” information related to mental health such as coping skills, social relatedness, a person’s worldview, rigidity, and communication style. Tests include, but are not limited to: MMPI-2, MCMI-IV, Rorschach Inkblot Test, Sentence Completion Test, TAT, House-Tree-Person, and Figure Drawing.

These tests are used to determine strengths and weaknesses in many thinking and reasoning domains including: general awareness, attention, memory, verbal comprehension, visual-spatial ability, computation, abstract thought, impulsivity, problem solving, social comprehension, processing speed, and judgment. They can also help rule out thought disorders and screen for brain dysfunction. These tests evaluate intelligence and academic achievement levels, the possibility of learning differences, ADHD, learning disabilities of all sorts, memory and other processing problems, and other cognitive factors which may be contributing to functional limitations. Batteries include, but are not limited to: WAIS-IV, Stanford-Binet IV, Woodcock Johnson Tests of Achievement, Wechsler Individual Achievement Test, GORT-4, TOWL-4, Wechsler Memory Scale-III, and WRAML. Additional cognitive tests may be needed to further evaluate: ADHD, learning disabilities, visual/spatial processing, verbal learning, memory, processing speed, executive functioning, and other aspects of cognitive functioning.

Each resident will have a psychiatric evaluation and follow up visits with the Bridge House psychiatrist, Dr. Kiera Schlansky. This evaluation will aid in diagnosing any number of emotional, behavioral, or developmental disorders. Evaluations are made based on behaviors present and in relation to physical, genetic, environmental, social, cognitive (thinking), emotional, and educational factors that may be impacting a resident. Based on her evaluation of the resident and on input from other team members, Dr. Schlansky will prescribe psychotropic medications if they are appropriate.

All residents will undergo a routine medical evaluation by the Bridge House Medical Director to clear them for treatment and participation in the program. They will also be closely followed for medical and medication needs by the nursing staff. When indicated, other medical tests may be suggested by the Medical Director. These may include: sex hormone and thyroid tests, tests for parasitic or other infections, tests for sexually transmitted diseases, allergy tests, vision and hearing tests.

As an integral part of the overall evaluation, each resident will be participating in milieu assessment. This will include observations made by staff members and therapists of the resident’s daily activities, emotional state, behavior, and ability to cope under a wide variety of circumstances. To facilitate this, residents will be immersed within a therapeutic milieu at Bridge House with other residents and in the community while participating in a wide variety of activities. This will allow the treatment team and resident to identify issues, problems, and strengths en vivo as they arise.

Nutrition therapy at Bridge House centers on promoting optimal health, healing, and the prevention of nutrition-related disease. Each resident receives a comprehensive nutrition assessment that combines objective measurements, a focused dietary history, physical examination, and a review of dietary and lifestyle factors to then determine each resident’s nutritional status and nutrition therapy intervention. The key function of our nutritional assessment is to determine the need for therapeutic dietary adjustments and nutrition as well as to provide any health education needs.

Behavioral assessments can be utilized to screen for ADHD, risk of self-harm, aggression, conduct problems, and treatment compliance. These batteries can help understand an individual’s approach to problems, attentional issues, and coping and social skills. We are able to screen for behaviors that are high risk, illegal, or violate the rights of others or major social values. Batteries include: Behavioral Checklists: BRIEF-2, Conners 3 ADHD Rating Scales, Mood Disorders Questionnaire, and Bipolar Sentence Completion.

These batteries are used to assess a variety of educational and job-related skills, interests, and goals in order to help plan for job, technical school, college, government program, or other career placements. These tests provide guidance for those re-entering the workforce, considering career changes, seeking to find a career that will be satisfying, and/or successfully managing vocational and educational transitions. They can estimate an individual’s confidence in his or her ability to perform various occupational activities, pinpoint areas of academic study that increase career options, and support personal counseling by identifying occupations or vocations that help meet the individual’s needs. Batteries include: Campbell Interest and Skill Survey, Strong Interest Inventory, and others.

Physical therapy evaluations will be utilized as indicated, if physical disabilities, limitations, or injuries are impacting mental health adaptation, or the resident’s ability to actively participate in the program.

Occupational therapy evaluations will be utilized as indicated to identify an individual’s sensory processing patterns and to identify and prioritize issues that restrict or impact performance in everyday living. Batteries include: Sensory Profile and The Canadian Occupational Performance. Psychiatric Evaluation

This includes tests to evaluate the severity of alcohol and drug problems, level of risk for relapse, the potential for legal problems related to substance abuse, and a resident’s current understanding of substance use issues. Tests may include: SASSI-3, Alcohol Use Questionnaire and other tests evaluating addiction issues.

Specific neuropsychological testing with a neurologist or neuropsychologist will be utilized as indicated, to evaluate the possibility of brain damage due to head trauma, concussions, asphyxiation, medical problems, complicated birth, or other problems which may have impacted brain or neurological functioning, or have contributed to a sudden or remarkable decline in functioning. Results from this testing may result in a recommendation for medical tests such as CT or MRI scans. Tests include: Bender Visual-Motor Gestalt Test, Neurological Mental Status Exam, Halstead-Reitan, Rey Complex Figure Test, Dellis Kaplan Executive Function System, and many others.  Some neuropsychological tests may be included as part of the psycho-educational test battery.  

Some residents may want or need assessment in other life areas. Assessment by outside clinicians is available to evaluate psychosexual issues, vocational aptitude, perceptual abnormalities, vision, hearing, speech and language, balance, coordination, and a wide variety of medical issues. These assessments can be discussed with the resident’s treatment team.

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