Client Assessment

Chapter 8

A Joint Activity

“As a joint activity by both the social worker and the client, assessment requires their mutual understanding and agreement.”

Cynthia D. Bisman, Social Work Assessment: Case Theory Construction, 1999.

Social Diagnosis

“Social diagnosis is the attempt to arrive at as exact a definition as possible of the social situation and personality of a given client. The gathering of evidence, or investigation, begins the process, the critical examination and comparison of evidence follows, and last come its interpretation and the definition of the social difficulty.”

Mary Richmond, Social Diagnosis, 1917

Client Assessment

Assessment is an ongoing process Dynamic Multidimensional

Client assessment is a synergistic process that begins before first contact and does not end until the work is completed.

The Assessment Circle

client

worker

related systems

The assessment circle represents the interrelated nature of the systems which interact in the assessment process.

General Overview

Introduction to the social work perspective and purpose of assessment.

Assessment skills and tools. Gathering and organizing assessment

information. Introduction to the medical model. Initial assessment formation. The DAC model. Theory & Conceptualization

Assessment Constraints and Factors of Influence

model of practice agency purpose and mission philosophy agency contractual considerations client contractual considerations access time resources

Assessment Tools

Standardized Graphic representations Written Historical Theoretical Personal interaction Professional & paraprofessional Use of self

Standardized Tools Standardized tests, interviews and agency forms

standardized instrumentsBeck depression inventoryMMPIRorschachIntelligence testsChild Behavior ChecklistASIS

There are many commercial tests and assessment instruments in use. Some of these instruments must be administered or interpreted by a licensed psychiatrist, psychologist, or other specially trained personnel.

Beck Depression Inventory

The Beck Depression Inventory is both valid and reliable. It was created by Aaron Beck who was doing research on cognitive treatment of clinical depression. He was forced to create a means of testing for depression when he discovered that no other reliable instrument existed.

The BDI

Take a few moments to look at the BDI. http://www.ibogaine.desk.nl/graphics/3639b1c_23.pdf

Do you think that the BDI is a reasonably accurate measurement of depression?

Do you see any problems with this instrument that might effect accuracy?

The Rosenberg Scale

The Rosenberg Scale is freely available and in the public domain. It is another example of a standardized tool that you can use when working with clients.

Rosenberg Scale http://

www.atkinson.yorku.ca/~psyctest/rosenbrg.pdf

Graphic Representations Examples

time line eco-map genograms family sculpting

A powerful assessment tool which are frequently constructed by social workers in collaboration with the client.

The process of constructing a graphical representation frequently enhances the therapeutic relationship and is often an enjoyable and goal directed activity for client and worker.

Sample Eco-maps and

Resources

http://www.ohiocla.com/Year

%205%20Revisions/ecomap1.htm

http://www.dss.mo.gov/cd/info/cwmanual/section7/ch1_33/

sec7ch25.htm

Sample Personal Timeline

The Chronological Timeline

Take out a sheet of paper.

Create a chronological timeline of your life. Do you think that a timeline would be useful

in a client assessment? What are the strengths and weaknesses of a

timeline?

Written Assessment Tools

Written intake & contact forms (usually standardized

by the agency) worker notes (sometimes standardized by the

agency particularly for documentation related to financial reimbursement)

problem lists social history (psychosocial)

Historical Assessment Tools Historical records are simply documents generated by

someone other than yourself. Historical records may, or may not, be available to you. For example: Past records generated and maintained by the agency Records which are sent as part of a referral process Records which are requested, using proper release of

information protocols, by the worker or the agency. These records take time and planning to obtain.

Historical records are useful but must be used with caution. Historical records can contain inaccuracies or outdated information.

The Use of Social Work Theory In Assessment

The unique perspective of social work practice is a powerful assessment tool.

Theoretical social work perspectives PIE: person-in-environment Strengths perspective Systems and ecological theory

Personal Interaction & Contact Your personal interaction is also a valuable

assessment tool. During each contact, even telephone contact, you are gathering assessment information.

Personal interaction formal interventions (during regularly

scheduled meetings) informal contact - These are interactions which

occur when greeting the client, giving a tour of the agency, etc. The amount varies from setting to setting.

Professional & Paraprofessional Collaboration

The information you gather from professional personnel (physicians, nurses, teachers, psychologists, speech therapist, etc.).

The information you gather from paraprofessional personnel (program or case aides, office support personnel).

Supervision & Peer Collaboration Agency liaison - personnel assigned to the client, to

your agency or both. This important assessment tool is sometimes

formalized into treatment teams.

Use of Self

These are your unique personal characteristics and skills. knowledge, skills and values experience specialized knowledge or training intuitive and deductive reasoning research

Medical Model In Assessment

Social work is not based on a medical model. However, ever social worker and client interact

with systems which are based in varying degrees on the medical model of practice.

Medical Model: A definition

The medical model of practice is based on the belief that the client has an illness, disease or dysfunction which needs to be treated by trained professionals.

The “patient” is first diagnosed and then treated.

Social Work and the Medical Model

Social workers must coexists, interact, and even work within systems influenced by, or even dominated by, the medical model.

Collaboration with the medical model is possible but social workers must not loose their unique perspective (person-in-environment and holistic approach) or they cease to function as a social worker.

The DSM-IV

The Diagnostic and Statistical Manual, version four, is maintained and published by the American Psychiatric Association.

The manual is written from the perspective of the medical model.

The ICD-9CM

The International Classification of Diseases, 9th Revision, Clinical Modification is based on the World Health Organization’s International Classifications of Diseases.

It is designed for classification of morbidity and mortality information as well as statistical purposes.

ICD-9CM classifications are required by Medicaid and Medicare as well as most insurance companies. DSM-IV and ICD-9CM classifications are roughly the same. However, one should not be used in place of the other.

ICD-9CM has psychiatric disorders listed in much the same way as the DSM-IV.

DAC

Description, Assessment and Contract

A Social History, Initial Assessment & Contracting Model

The DAC Social History Model

The DAC social history model has three major divisions:

I. Description II. Initial Assessment III. Contract

Description - part I

Description Client Identification Systems:

person (micro)family and household (mezzo)ecological (macro)

Issues of concern Strengths, competencies, and resources Referral source and process/collateral information

Descriptive (cont.) - Social History

developmental personal and family critical life events sexual substance abuse medical/physical legal

educational vocational recreational spiritual prior psychological

or social service interventions

other

Initial Assessment - Part II

Person identity and structure mood and emotion life cycle development competence risk

Family/Household/Primary Social Systems identity and

structure mood and emotion life cycle

development Environment

resources social and cultural

Contract - Part III Issues

client-identified issues

worker-identified issues

agree upon issues for work

Goals

Plans action plan client task and action

steps work task and action

steps In-session task and

action steps Maintenance tasks Plans to evaluate

progress

Written Records Your written notes, summaries and reports are legal

documents. Written work should be

accurate timely terse

AVOID verbose, and judgmental writing. Write nothing that you can not defend to your

supervisor, professional organizations, state agencies, the legal system and the client.

Written records can be reviewed, audited or subpoenaed by more people than you might think.

Theory

From Idea to Theory

An Idea is a relatively unstructured thing. However, ideas are the building blocks of conceptualization and conceptualization is the building block block of theory.

Theories ad structure and discipline to our ideas.

Conceptualization

The process of assigning words to ideas, abstractions, and constructions of empirical reality.

What is a theory?

Theories are human inventions, nets, that are designed to catch the world.

Karl Popper, philosopher (1988)

In drawing patters from observations to explain phenomena, different persons may explain the same events with a range of theories. The theory is not real but rather is the individual’s attempt to explain real things. Cynthia Bisman, 1999

Theory & Assessment

Theory exists in an individuals overall understanding of the world around them. Why and how things are the way they are.

Theory is created in the assessment process.

Is it possible to separate the theory created in assessment from our world view?

Theory Building & Assessment

Theory building is a part of the assessment process. In theory building we develop a conceptualization of the situation. Cause and effect. If-then propositions.