Psychological and Neuropsychological Assessment

Case Managers Role

During the initial exam and on subsequent interactions with the client, Case Managers should assess:

  • temporary or permanent functional changes
  • physiological, psychological or social problems
  • problems functioning in the community

This can be done by observation and if the need for further assessment is indicated a variety of tests are available. The case manager does not necessarily perform these assessments, but rather may be making referrals for them. A medical evaluation should be performed prior to psychological evaluation to rule out underlying medical conditions that can cause behavioral symptoms. 

Once all of the information is available an experienced professional should interpret the data to make a diagnosis. They will review the:

  • Independent medical evaluation
  • personal interview
  • review of psychiatric records
  • psychological tests

Assessment Tools

Rancho Los Amigos Levels of Cognitive Functioning

The Rancho Los Amigos Scale of Cognitive Functioning is used to follow the recovery of the traumatic brain injury(TBI) patient.The scale is divided into eight stages, from coma to appropriate behavior and cognitive functioning. Those stages include:

I= Unresponsive to all stimuli
II= Generalized response to stimuli
III= Localized response to stimuli
IV= Confused/agitated
V= Confused/inappropriate, nonagitated behavior
VI= Confused appropriate behavior
VII= Automatic/appropriate behavior
VIII= Purposeful/appropriate behavior


Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition, better known as the DSM-IV. The DSM uses a multiaxial approach to diagnosing because it is rare that other factors in a person’s life do not impact their mental health.  It assesses five dimensions as described below:

Axis I: Clinical Disorders
This is what we typically think of as the diagnosis (e.g., depression, schizophrenia, social phobia). These may come and go.

Axis II:  Developmental Disorders and Personality Disorders
These are lifelong and enduring. Developmental disorders include autism and mental retardation, disorders which are typically first evident in childhood. Personality disorders are clinical syndromes which have a more long lasting symptoms and impact the individual’s way of interacting with the world.  They include Paranoid, Antisocial, and Borderline Personality Disorders.

Axis III: General Medical Conditions
Physical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders. These are important even when a problem seems to be mental or behavioral, because sometimes psychological problems are the byproduct of an illness.

Axis IV: Psychosocial and Environmental Problems
Events in a persons life such as; poverty, dysfunctional families, death of a loved one, unemployment, starting a new job, college, that might have some impact on the person’s ability to function and can impact the disorders listed in Axis I and II.

Axis V: Global Assessment of Functioning Scale
The clinician rates the person’s level of functioning both at the present time and the highest level within the previous year.  This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected.
The rating goes from low scores of 10 (Persistent danger of severely hurting self or others) to 100 (Superior functioning in a wide range of activities).

Minnesota Multiphasic Personality Inventory (MMPI)

The MMPI is a psychological test that assesses personality traits and psychopathology. It is most commonly used by mental health professionals to assess and diagnose mental illness. It can only be given and interpreted by a psychologist trained to do so.