engaging clients in the assessment process for …

Assessment Skills Workshop Community Support Services Common Assessment Project

CSS Common Assessment Project

Assessment Skills Workshop Facilitator’s Manual

ENGAGING CLIENTS IN THE ASSESSMENT PROCESS

FOR COMMUNITY SUPPORT SERVICES &

COMMUNITY MENTAL HEALTH

Assessment Skills Workshop Common Assessment Projects

Facilitator’s Manual 2


Disclaimer These educational materials may be copied or distributed without permission solely for educational and implementation purposes, provided that (i) this notice is reproduced on all copies, and (ii) these materials are not modified in any way, neither provided nor distributed alone or in conjunction with any other materials, for money or other consideration. These educational materials are provided and designed for use with the education and implementation support program provided by the Common Assessment Projects (CAPs). These materials alone are not sufficient for a successful and complete common assessment implementation. This education material and the information contained herein are proprietary to Community Care Information Management (CCIM). The recipient of this information, by its retention and use, agrees to protect it from any loss, theft or compromise.




Assessment Skills Workshop: Overview The Assessment Skills Workshop has been developed to meet the needs of the community health care assessor. The intended participants are community health care workers who have direct client contact.

The focus of this workshop is to discuss strategies on how to engage clients in the interview process, how to introduce clients to the assessment process and how to involve them in conversations that will yield information to complete the assessment.

In this workshop, we will be referring to consumers, members and clients generically as client. Feel free to use the term that you are most comfortable with. The term assessor will appear frequently in this material and refers to the person who is completing the standardized assessment with the client. The assessor can also be referred to as worker, wellness worker, staff, etc..

This is an interactive workshop with many breakout activity sessions. The workshop will adhere to adult learning principles. It is expected that the facilitator will: Facilitate learning while transmitting knowledge. Support learners to develop their own understanding of the concepts. Empower all learners to bring their perspective into the classroom. Respond to the needs of the group. Guide and direct the course of the workshop by asking questions, exploring options and suggesting

alternatives.

Sharing Experiences and the Art of Reflection Adults bring their work and life experience into the classroom. Participants’ prior knowledge and experience related to the workshop will be the starting point of instruction. Facilitators are expected to employ numerous strategies to encourage workshop participants to share their experiences with assessment in the community health care sector. These strategies include: Sharing experiences. Creating opportunities for discussion to relate experience to workshop material. Promoting a sense of safety, openness and trust where learners feel secure and are okay to experience risk

and personal exploration. Encouraging learner autonomy, confidence, participation and collaboration; learners are not alone, empower

your learners. Offering activities that encourage the exploration of alternative personal perspectives via challenging

participant assumptions, problem posing and critical reflection. Offering activities that encourage the exploration of alternative personal perspectives via challenging

participant assumptions, problem posing and critical reflection. Facilitating in a way that offers time for dialogue, critical reflection.




What is Assessment?

“I'm a great believer that any tool that enhances communication has profound effects in terms of how people can learn from each other, and how they can achieve the kind of freedoms that they're interested in .”

Bill Gates

Assessment can be thought of as: A dynamic and ongoing collaborative process that occurs during each interaction. Actively involves the client and others to gather information in an individualized manner. Uses a standardized format to identify client needs and priorities. Information gathered drives service planning.

Who is Involved in the Assessment Process? The most important source of information is the client. Several sources of information will feed the common assessment. Sources of information may include family members, significant others, community service workers, mental health workers, physicians, nurses, other service providers as well as past records. Obtaining client consent while conducting this research will probably be necessary—please consult the privacy and security officer within your health service provider organization for more information.

Where Does Assessment Happen? Assessment interviews may take place in any location that meets the client’s needs. This may require a flexible approach to where the assessment process happens, enabling assessors to collect information during a home visit, telephone call, visit to a day centre or health centre.

How is Assessment Information Collected and Recorded? It is important to distinguish the gathering of assessment information from the recording and the entry/input of the information. Assessment information is gathered verbally during the assessment interview. The decision to also record and input the information into the computer during this time is influenced by the comfort level of the client. Clients familiar with computers may be comfortable with the direct use of computers, others may prefer to have the assessor take notes and enter data later, and others may prefer to have an informal conversation with notes being taken later. Others may be reassured by the use of the computer — they may be relieved that the assessor is savvy with technology. Ultimately, the conclusions drawn from the information gathered through the assessment are recorded in the assessment software.

What is a Common Assessment? A common assessment tool is a standardized, client-centred assessment that allows information to be electronically gathered in a quick, secure and efficient manner. The common assessment should be completed by someone beginning to establish a rapport with a client, used as a focus for care planning and used as a review mechanism, as it records assessment information at a particular point in time.




Why Participate in an Assessment Skills Workshop?

Objectives of the Workshop The objective is to increase the participant’s knowledge about the assessment process, in the following key areas: Characteristics of effective communication Role of the assessor in the assessment process Interviewing, observing and listening skills Communication practices in different cultures Benefits of a common assessment tool

How Will the Assessment Skills Workshop Achieve These Objectives? This workshop will offer assessors the opportunity to learn, develop and enhance current assessment skills. Participants will have the opportunity to practice verbal and nonverbal communications skills that will enhance their practices in a safe learning environment. The workshop will incorporate the assessor’s perspectives, experiences and expertise in an attempt to answer the question: “How can we best use assessment interviewing to engage clients in the assessment process?”

How Long is the Assessment Skill Workshop? The Assessment Skills Workshop is a one-day interactive session with morning, afternoon and lunch breaks.

What Materials are Needed to Participate in this Workshop? Participants will be provided with all material needed to participate in this workshop. The materials include: A participant workbook A PowerPoint presentation Role-play vignettes One-page reference sheets A copy of an assessment form for the role play Electronic evaluation form

Let’s get started!




Facilitator Preparation All material required to facilitate an Assessment Skills Workshop is included in this manual. A paper copy of the education material will be provided to the facilitator by the project team.

The material will be posted on the CCIM website. Education material on the website will include: Assessment Skills Workshop Facilitator’s Manual Participant’s workbook PowerPoint presentation with speaker’s notes Role-play vignettes One-page reference sheets

Material required for running a workshop include: Facilitator’s manual Workshop manual for each participant Copy of PowerPoint with notes Copy of PowerPoint downloaded onto memory stick (do not run PowerPoint from website) Four to five flip charts (one per group of three) or one flip chart stand with plenty flip chart paper Masking tape Markers LCD projector Laptop computer for facilitator Extension cords

Things to consider before running a successful Assessment Skills Workshop: Booking the room Booking the projector Printing the materials Organizing refreshments Deciding on participants Sending invitations Making travel arrangements Timing of the workshop Setting up room to accommodate participants and activities Familiarizing with amenities—washrooms, refreshments Bringing extra writing paper, pens

Note to the Facilitator | Setting the Stage:

The PowerPoint presentation and the speaker’s related notes are meant to be used by the facilitator as a guide to the training day to ensure the day has a standardized structure.

Background for activities as well as debrief information can be found on the next few pages.

Participants are required to complete an evaluation for the Assessment Skills Workshop by survey monkey, following the workshop.

Following is a detailed agenda that the facilitator may follow to offer a standardized workshop approach:




Agenda




Activity Participant Exercise: Community of Knowledge

Introductions

Duration: 30 minutes

Format: Individuals in the group will move around the room talking with other participants

Intent: To demonstrate that assessors gain information about individuals from a variety of sources. By the end of the activity, participants will have practiced different engagement styles in order to obtain more information about their colleagues.

Assumptions: Participants may know each other but they don’t know everything about each other. This exercise will get the energy flowing, build rapport and set the climate for role-plays. The exercise is linked to the topic of assessment skills, as it has the participants using different engagement

techniques to obtain information about each other. Each participant will be introduced to the group by a number of different people in the group. This will facilitate a discussion around how assessment information may come from many different sources.

Although colleagues may know each other, they may not know everything about them. This activity allows participants to engage in meaningful dialogue to practice different engagement techniques.

Materials Required: Participant’s workbook–Community of Knowledge: Worksheet, flip chart, markers, note paper, extra pens or pencils, watch

Facilitation Instructions: Since we are talking about assessment skills today, let’s begin by having participants interview each other by

asking one question of each participant, recording their name and response on the sheet provided and moving on. The aim is to demonstrate that individually we may not have all of the information about a person but that collectively we can paint a much more colourful picture.

Instruct participants to interview other participants in the room using different engagement techniques to find out information about that person that others may not know.

You may have the opportunity to speak to 16 people…16 spots on the worksheet. Time may restrict to getting assessment information from only 5 other participants Indicate that after 30 seconds the participants will be asked to switch roles and the person interviewing will

be the interviewee, etc… This will go on for 10–15 minutes depending on the group size. Interviewees can only respond to the one question posed. They cannot volunteer additional information. Interviewees can provide only information that they have not provided to a prior assessor.

Debrief: What connections can you make about this exercise and assessment? How would you describe the quality of the information you received? Did anything surprise you? Would you do anything differently? Who was the easiest to interview? Who was the hardest?




You know how to complete an assessment. It was done from a social conversational perspective. Some people stick to a scripted format, versus others who create new questions for each person. Some people ask safe questions, others are more adventurous.

There is no right or wrong way to assess; we adapt to meet the client’s needs.




How Do Clients Want to be Treated?

“No one cares what you know until they know how much you care.” Theodore Roosevelt

Research has shown that there are six behaviours important to clients during the assessment process: They want to be cared about as a person. They want to know that they are being listened to. The assessor’s ability to give clear information, knowledge about the client’s medical history. The ability to work with the client on decision making. The assessor demonstrates competent knowledge and skill. The assessor uses client language; for example, the assessor is able to talk, discuss and ask questions in

the same language and terminology of the client.




Activity Participant Exercise (Reflective Activity): Self-Evaluation of Assessment Strengths and Challenges


Format: Independent work

Intent: For assessors to have the opportunity to reflect on their own current assessment skill level and areas that may be challenging. Examples of challenging areas may be specific topics of assessment (such as sexual health, mental health issues), client’s experience with trauma and psychological distress, etc. This information will link to another activity later in the day. Encourage participants to give thoughtful reflection to this exercise to ensure a robust day.

Assumptions: Participants in the room will have varying degrees of skill and comfort levels in completing assessments. The number of assessments completed by each participant will vary, depending on the agency and job. Participants understand which common assessment tool has been chosen for their sector.

Materials Required: Participant’s workbook, sticky notes, markers

Facilitation Instructions: This is an opportunity for participants to reflect on their own comfort level completing assessment. Participants are asked to use the “Participant Skills and Needs Analysis” worksheet. It will not be handed in. Participants will be instructed to reflect on their strengths and challenges as we move forward—beyond

today. Participants will record the Challenges information on a sticky note and place it on the flip chart paper. In the large group setting, review the challenges noted on the flip chart paper and let the participant know

that the group will be revisiting and brainstorming around how to deal with these. At lunch, the facilitator will take the sticky notes and put them thematically in order…three top challenges will

be flipcharted and used for the “Challenging Assessment Interview Exercise” slide.

Debrief: To end on a positive note, the facilitator will go around the room and ask each participant to share one

strength with the group (you have the opportunity to debrief or flip chart it to celebrate successes at the end of the day).




Assessment Skills Workshop Participant Skills and Needs Analysis

Subject Area Strength Challenges I am aware and able to apply the use of verbal and nonverbal cues when communicating.

I am able to conduct an assessment using a wide range of communication strategies and effective interpersonal skills.

I am able to engage in therapeutic communication with a client during the assessment process in persona and/or over the telephone.

I am able to establish a trusting relationship.

I am able to control the direction of the assessment interview.

I am comfortable using open-ended and closed-ended questions to conduct my intake assessment, when appropriate.

I am able to effectively communicate a service plan to the client.

I am able to communicate with “difficult” clients effectively.

I am comfortable using a holistic approach to the intake assessment process (e.g., assess the whole client, not just the presenting problem — looking at a person’s overall wellness from a physical, spiritual, emotional and mental perspective).

I am comfortable asking questions related to:

Mental Health Emotional Well Being Physical Health Spiritual/Religious Beliefs Sexual Health Client Experiences of Trauma Psychological Distress Overall Needs Overall Strengths Current Support(s) Received Support(s) Needed




Activity Sharing Assessment Experiences

Background/Participant Reading Assessment interviewing is a topic that many participants are very familiar with. Their perspectives, experiences and expertise will guide the discussion and help answer the question: “How can we best use assessment interviewing to engage clients in the assessment process?”

Let’s start the discussion about the assessment interview by reflecting on previous experiences. What do you recall about those experiences?

The facilitator may want to have an example of an assessment interviewing experience “in their back pocket,” to be used to initiate the discussion.

Reflective questions may include: What role or setting were you in? How would you describe your initial assessment interviewing experiences? What were they like for you? What were they like for the people that you interviewed? What was your most important learning from your first assessment interviewing experiences? How have those experiences influenced how you conduct assessment interviews today?


Format: Pairs

Intent: To provide an opportunity for participants to reflect on positive, touching and challenging past experiences with the assessment process. To encourage participants to share their assessment interviewing perspectives, experiences and expertise.

Assumptions: Participants are experienced service providers. Participants will enjoy reflecting on their assessment interviewing experiences. Participants will enjoy sharing their experiences about assessment interviewing. By encouraging participants to connect with and share their interview experiences in pairs, they will be

invested in continuing to share their perspectives, experiences and expertise in a variety of ways throughout the workshop.

Materials: Participant’s workbook, flip chart and markers.

Facilitation Instructions: In this exercise, participants are asked to think about three assessment experiences that they have had with clients in the community: The most challenging assessment interview. The most unconventional assessment interview. The most touching assessment interview.

Following are instructions to set up the exercise: Participants have a total of 30 minutes to complete the exercise. Participants should work in pairs. They should pair off with someone sitting close.




One person will be the assessor and the other the interviewee. After 15 minutes, participants will reverse roles. The assessor will interview the person about their interviewing experiences—the most challenging, most

unconventional and most touching. At the conclusion of the interview, participants will record the three learnings/reflections in their workbook. The objective is to determine the most important learning from each of the experiences.

Debrief: Have 3 pieces of flip chart paper with the 3 headings and write down “key” messages/pieces of information that are relevant to the headings (e.g., most challenging may be the environment with tv blaring, kids running around, etc.). Debrief this exercise by asking a participant to recollect a story for each heading.

Note the themes. You may choose to ask all or a few of the following questions: Overall, what was your experience of this exercise? As the interviewee, what did you learn from your interview experiences? What did you learn as an assessor?

How did you build trust? What were the important themes? What were the most important reflections from the most challenging

assessment interview experience, the most unconventional and the most touching? Participants will be able to use this information during the role play exercise later in the day.

Participant Exercise: Sharing Assessment Experiences The following tables appear in the participant’s workbook for the Sharing Assessment Experiences exercise.

Most challenging assessment interview:

NOTES LEARNING

Most unconventional assessment interview:

NOTES LEARNING

Most touching assessment interview:

NOTES LEARNING




Activity Assessor Personal Values, Knowledge and Skills What does the assessor bring to the assessment experience—their values, their knowledge, and their skill?


Format: Individual exercise with larger group discussion

Intent: To give assessors an opportunity to reflect on the breadth and depth of the skills they already possess that contribute to a successful assessment. This will acknowledge and validate the skills they already possess.

Assumptions: Participants will brainstorm a general list of personal values, knowledge and skills that they bring to

their work as community health care assessors. Identifying the key personal values, knowledge and skill will invite deeper reflection.

Materials: Participant’s workbook, flipchart and markers.

Facilitation Instructions: Participants should turn to the assessor values, knowledge and skill section in the participant’s workbook. In small groups at their tables, ask participants to take 10 minutes to brainstorm lists of:

– The sources of knowledge that the assessor brings to the assessment process. – Skills that are critical in conducting an assessment interview. – The single personal attribute, source of knowledge and critical skill that they have come to realize are

particularly important during an assessment interview. Each table will report back to the larger group.

Debrief: Invite participants to read their brainstormed list out loud. The following list includes some suggestions of what may be less readily identified attributes. Mention some

of these if they aren’t generated during the discussion. Positive staff attributes that support assessment: – Compassion, curiousity, hopefulness, humility, gentleness. – Persistence, respect, commitment, tact, diplomacy. – Low-key, calm approach, tolerance, sense of humour. Possible sources of knowledge that can contribute to assessment interviewing include: – Knowledge of the person, family. – Involvement with other community and social services. – Common assessment tool. – Assessment process and assessment administration.




Assessor Personal Values, Knowledge and Skills (Continued) The following tables appear in the participant’s workbook for the Sharing Assessment Experiences exercise.

What do you bring to the conversation?

Personal Values (e.g., trust, honesty, compassion)

Knowledge (i.e., education, prior work experience)

Skills or Tools (e.g., curiousity used to engage client and quickly build trusting relationship)




Activity Communication Skills: Setting the Tone

“Communication can be considered the primary medium of care delivery. It is a process between two or more people that is born out of a relationship”

(Moore, 2005, p. 12).

Basic interpersonal skills, such as good attending behaviour, use of open-ended questions and use of active listening skills, promote a rapport that is the foundation of an effective working relationship. The community health care worker can provide an appropriate setting for optimal communication to support a client’s feeling that they are being listened to and cared about. The appropriate environment for an assessment interview should be private and comfortable, and it should allow for enough time to process information and include the client’s support system, if available.

Twelve Communication Strategies The College of Nurses (2005) outlined twelve communication strategies that strengthen the nurse-client relationship. These same strategies may be applied to the community health care worker-client relationship. Imagine how you would like a community health care assessor to treat a close relative, and then model that

behaviour. Introduce yourself by name and title. Use the client’s preferred name (not sweetie or dear). Make eye contact (when culturally appropriate) and be aware of your body language. Ask your client open-ended questions to encourage more than a yes-or-no response. Listen actively to show an interest in your clients. Inquire into unusual comments or behaviours. Identify your client’s care needs and goals. Provide sufficient information for clients to make choices and have realistic expectations. Collaborate with your client to find the best possible solutions. Follow through on your client commitments and notify clients of any changes in routine. Reflect on how your clients perceive you.

Nonverbal and Verbal Communications Strategies Nonverbal communication skills set the stage for rapport building and empathetic communication. Support may be provided through nonverbal channels, such as: Directly facing the client Being at eye level Limiting distractions Maintaining an open posture and appropriate eye contact. Closed posture—arms folded across the chest or

legs tightly crossed—can suggest defensiveness and the desire to be cut off from what is being said.

Verbal support may be provided by: Using open-ended questions—although more time-consuming—allows clients to express what is most

important to them Permitting the client to discuss their problems uninterrupted and at their own pace, so the assessor can gain

valuable insight into the client’s unique experience of illness.




Paraphrasing, which involves repeating back to the client the content of the communication by using some of the client’s own words. Paraphrasing can show empathy and promote rapport and trust. Be cautious not to “parrot” what the client said. However, by repeating back the essence of the client’s communication, any misunderstandings can be clarified. When paraphrasing is used, understanding is enhanced.

Assessment Communication Techniques Communication Techniques Example Using silence Sometimes empathetic silence is more helpful than a verbal response.

Temporarily slows down the pace of conversation. Gives client chance to reflect upon/and speak further about their feelings.

Accepting Yes Right I understand what you said Nodding

Using broad-opening statements Broad-opening questions give the client an opportunity to begin to express him/herself Is there something else you’d like to discuss? Where would you like to start? Is there something disturbing you?

Offering general leads Tell me about this situation… And then…

Placing events in time and sequence When did this happen? Did this happen before or after?

Sharing observations Sharing observations focuses on the individual’s physical or apparent emotional state and conveys to him/her your concern and your interest in further discussion: You appear concerned You seem distressed You are shaking

Reflecting

Reflection allows the assessor to show that he/she is aware of the feelings being expressed in words, voice tones, facial expression or body language. This allows the client to talk further about their feelings in a non-threatening way. Client states: “Nobody pays attention to what I have to say.” Reply: “Nobody listens?” Or Client states: “I am so frustrated.” Reply: “Frustrated?”

Focusing This point seems worth looking at more closely.

Exploring Tell me more about that.

Seeking clarification This ensures that you have the facts straight and provides the opportunity to make meaning clear in order to prevent misunderstanding. I am not sure I understand what you are saying. Are you using this word to mean…? Tell me more about…

Acknowledging client’s feelings Help the client to know that his/her feelings are understood. This encourages the client to continue. Client states: “I don’t like Canada…the health care system is horrible. I wish

I could go back to my country.” Reply: “It must be difficult to live in a place you don’t like.”

Validating When you feel that a client need has been met, you should validate your impression.




Communication Techniques Example Do you feel more relaxed? Are you feeling better now?

Giving information My name is…. The reason for my visit today Our agency provides services such as…

Summarizing Summarization allows the assessor to bring the discussion into focus to serve as a springboard for further discussion. So putting it all together, I think you mean…

Restating/paraphrasing I hear you saying… As I understand it, your idea is… What I think you mean…

Nonverbal Communication Techniques When we talk to someone, we often concentrate only on what is being said. Most of the time, we do not realize that people communicate as much through their body gestures as through verbal conversation. Nonverbal communication is called body language.

Body Language Effective body language involves: Eye contact Gestures Posture Intonation Mirroring facial images Active listening Be aware that cultures may vary in the use of nonverbal cues.

What we do is often more important than what we say.

Touching Touch is the most powerful nonverbal form of communication. Touch can convey warmth and caring. Touch induces relaxation, which can relieve anxiety. Cultural differences may dictate the degree of touching.

Personal space Generally refers to the distance one stands from another during a conversation.

Definite cultural differences in personal space.

Intrusion into one’s personal space may make a client uncomfortable, whereas standing too great a distance away may communicate a lack of concern.

The environment Talking to the client at the same level communicates equality and respect…pull up a chair or rearrange the furniture.

The physical environment can transmit the mood of the client…overcrowding, soft colours, bright colours, disorganization, etc.




Ineffective Communication Techniques Ineffective Techniques Examples Reassuring “Oh, everything will be perfect.”

“There is no need for you to worry.” “You are doing just fine.” “I wouldn’t worry about…” These statements tend to minimize the client’s feelings or convey a lack of understanding or interest in his/her problem.

Giving advice “What I think you should do is…” “This is what you should tell your doctor…” The assessor has imposed their opinions and solutions on the client rather than helping the client to explore his/her thoughts so that they can arrive at their own solutions.

Disagreeing The assessor may give the client the impression that what he/she said is not acceptable. Judgment may cause the client to become defensive/threatened. Client states: “People ignore me all the time.” Reply: “I don’t think that is true.”

Defending “No one would do/say such a thing.”

Requesting an explanation “Why do you think that…?” Questions that ask “why” are often intimidating, since the client may be unwilling or unable to answer.

Making stereotyped comments “It is for your own good.” “Don’t argue with your doctor…he knows best.” “Have a good day.” May keep conversation at a superficial level.




Embracing Diversity: Individual Recommendations According to a publication produced by the Registered Nurses’ Association of Ontario (i.e., Embracing Cultural Diversity in Health Care: Developing Cultural Competence), for each individual, embracing diversity means development of the following competencies and behaviours.

A. Self Awareness – To learn to embrace diversity in individuals: Perform self-reflection of one’s own value/beliefs, incorporating feedback from peers. Express an awareness of one’s own views of differences among people (e.g., different opinions, different

world views, different races, different values, different views of society). State and continually explore, through reflection and feedback, how one’s own biases, personal values and

beliefs affect others. Identify cultural differences among clients and colleagues in a practice setting. Acknowledge one’s own feeling and behaviours toward working with clients, families and colleagues who

have different cultural backgrounds, health behaviours, belief systems and work practices. Explore one’s strategies for resolving conflicts that arise between self and colleagues and/or clients from

diverse groups. Identify and seek guidance, support, knowledge and skills from role models who demonstrate cultural

proficiency. Recognize and address inequitable, discriminatory and/or racist behaviours or institutional practices when

they occur. Acknowledge the presence or absence of individuals from diverse cultural backgrounds at all levels in the

workplace, reflecting the cultural makeup of the clients or community being served. Reflect and act on ways to be inclusive in all aspects of one’s practice.

B. Communication – To develop communication skills that promote culturally diverse settings: Are aware of different communication styles and the influence of culture on communication. Are aware of one’s preferred communication style, its strengths and limitations, and how it affects colleagues

and recipients of care. Seek feedback from clients and colleagues and participate in communication validation exercises (e.g., role-

playing exercises, case studies). Use a range of communication skills to effectively communicate with clients and colleagues (e.g., empathetic

listening, reflecting, non-judgmental and open-ended questioning). Seek and participate in learning opportunities that include a focus on communication and diversity.

Note:

If the group of participants is not a culturally diverse group or they do not work within a multi-cultural environment, provide a “light-touch” for slides 18 through 20. Otherwise, the facilitator will deliver these slides with the full intent and notes. Advise participants to review the Cultural Assessment Guide for the activity on slide 20 Communication Skills: Transcultural Assessment.




Activity Communication Skills: Transcultural Assessment This is a large-group activity, and the transcultural communication resource tool can be used internally to review your current client engagement processes. The intent is to have participants reflect on the relationship between cultural diversity and how the assessor frames the question.

Participants will discuss a few of the generic questions on the Transcultural Assessment Guide resource that follows and appears in the participant’s workbook. This is a reflective exercise for all assessors. Then we will move forward to discussing how we use those skills to engage with clients prior to starting the assessment. This exercises is meant to outline the importance of engaging with a client, and this means acknowledging who they are and the community they live in (as well as their gender, income level, culture, first language, etc.).

Engagement During the engagement process as an assessor, you are demonstrating a person-centered approach by meeting the client’s basic needs. This provides a sense of comfort and starts building the rapport needed to move forward with the assessment process. Building rapport with the client will facilitate a natural transition to the assessment process. Engaging someone to have a conversation about their needs can differ from setting to setting. In some settings, you will only have a short period of time to understand what people’s needs are; in others, you may have a number of contacts over a period of time. As you know, clients are all unique individuals and you need to adjust your engagement approach based on their personality, state and setting you are working with. Meeting someone one time in your office versus meeting a person two or three times a month in their home will affect what information you are able to get in order to address a person’s needs.

Resource: Transcultural Assessment Guide Assessment Area Optional Questions Culturally

Sensitive: Yes or No

Alternate Questions

Cultural identity/ancestry/heritage Where were you born?

Where were your parents born?

Ethnohistory How long have you/your parents resided in this country?

What is your ethnic background or ancestry?

How strongly are you influenced by your culture?

Why did you leave your homeland?

Social organization

(dominant in Western society, the most common unit of social organization is the nuclear family, where adult children are expected to establish separate residences from their parents; in other

Who lives with you?

Who do you consider members of your family?

Where do you live?

Where do other members of your family live?

How do you contact them?




Assessment Area Optional Questions Culturally Sensitive: Yes or No

Alternate Questions

cultures, family composition may be extended to distant blood relatives across generations, including non-blood)

How often do you have contact with your family members?

Who makes the decisions for you or your family?

Who do you go to outside of your family for support?

What do you expect your family members to do for you?

How different are your expectations of them from other times?

What expectations do you have of your family members who are males, females, old, or young?

Caring beliefs and practices

(refers to causes of illness, specifically the individual’s perception of what caused it and how it should be treated)

What do you do to keep yourself well?

What do you do to show someone you care?

How does your family or you take care of sick family members?

Which caregivers do you seek when you are sick?

How do you decide when to go and which one to go to?

How different is what we do from what your family does for you when you are sick?

Are we doing what you think we should be doing for you?

How should we give you care?

Experience with professional health care

(understanding about folk remedies and cultural healers used by the client that may be harmful [i.e., client’s use of an herbal remedy that interferes with a prescribed drug])

Since you came to this country, have you had contact with doctors or hospitals?

How do you compare your past experience with now?

What were some of the problems that you encountered?

How were they resolved?

What were the positive experiences you had?

What type of care provider do you prefer? Why?





Alternate Questions

If you have a choice, what changes do you wish to see?

Socioeconomic status What do you do for a living?

What did you do back in your homeland?

Where did you go to school?

What did you finish in school?

How different is your life here from back home?

Do you have a primary care provider?

Biocultural ecology and health risks

(i.e., certain genetic disorders are linked with specific ethnic groups; hypertension among Black Canadians or Tay-Sachs among Ashkenazi Jews)

What is your purpose for coming here?

What caused your problem?

Have you had this problem before?

Does this problem affect your life and your family? How?

Are there other members of your family with this kind of problem?

How do you treat this problem at home?

Who do you go to for this kind of problem?

What other plans do you have for dealing with this problem?

What do you think we should do for you?

What other problems do you have?

Have these problems occurred to any other members of your family?

Language and communication

(may be some variation in non-verbal communication among Aboriginal people [i.e., Cree view direct eye contact as controlling; Ojibwa view brief eye contact as acceptable when greeting a person and occasionally throughout an interview])

What language(s) do you speak at home?

What language(s) are you most comfortable speaking?

In what language(s) can you read and write?

How do you want us to talk to you?

How should we address or call you?

What kinds of communication upset or offend you?





Alternate Questions

What words would you use to describe how you feel?

Do you need an interpreter?

Would you prefer a female or male interpreter?

Religion/spirituality

(spirituality rather than religion, is the core meaning for such people as the Cree)

What is your religion?

Who is your religious or spiritual leader?

Do you want to be in touch with your religious leader?

How do we contact your spiritual leader?

What are some of the things we need to do within your religion?

How do you practice your religion?

Are there specific dietary practices you follow?

Canadian Fundamentals of Nursing, 3rd edition (2006)




Preparing for the Assessment Preparation for the assessment interview is important to establish trust. With experience, we tend to do this automatically. At this stage in the workshop, participants will reflect on the skills needed to prepare, conduct and conclude an assessment interview.

Assessment Interviewing Skills

Beginning the Assessment Preparing—The setting, resources and self. Orienting the client to the assessment interview:

– Purpose—Explore the client’s understanding of the assessment. – Content—Briefly outline the key components of the assessment. – Process—Describe how the assessment will be conducted. – Roles—Describe role of the client and role of the assessor. – Clarification—Affirm the client’s understanding of the interview process.

Conducting the Assessment Interview—Engaging and Listening Anyone can, by rote, ask a set of structured assessment questions. The art of engaging someone in the common assessment, however, rests with the ability and skill of the assessor in developing a series of interview questions. It is important that interview questions take into consideration who the client is and how the assessor can best encourage him/her to share perspectives and aspects of his/her life.

Engaging: Engages the client in the assessment interview – Assessment questions—Set of structured questions. – Interview questions—Take into consideration who the client is and how one can best encourage them to

share their perspectives and aspects of their lives. – There are different types of questions—Direct, closed and open. Direct questions seek specific information. For example: “Where do you live?” “How much is your

monthly income?” Closed questions invite a “yes” or “no” answer. For example: “Have you ever thought of living in

another place?” “Do you have enough money to last the month?” Open questions invite the person to elaborate. For example: “Describe the best place that you have

ever lived?” “What challenges have you faced in managing your money?” – Check-in: For example: “Are you okay?” “Is it okay to continue?” – Give the client permission not to answer questions.

Listening: Demonstrate understanding – Paraphrasing content—Using fresh words to clarify what the person is conveying. – Responding to meaning—Capturing the essence of what the person is expressing by incorporating their

words, feelings and nonverbal messages. – Acknowledging the person—Recognizing the qualities of the person—who they are. For example: “You

are a compassionate person”. “You are very astute”.




Concluding the Assessment Interview Concluding the assessment interview involves closing the interview as well as completing the assessment.

Note:

The client determines when the interview will end. The assessor needs to be sensitive to the client’s level of involvement, interest and energy.

In closing the interview, the assessor should clarify/explore the impact of the interview experience on the client.

Assessors should ask the client: – “How was this interview for you?” – “What have you learned from the assessment interview?” – “What have you become aware of as a result of our conversation?” – “How has the session influenced your next steps?”

Closing the interview: The assessor needs to be sensitive to the client’s level of involvement, interest and energy level. – Learning gained – Reflection on the experience – Next steps…

Completing the assessment: How the assessment information is gathered and input into the software will be influenced by the procedures in the agency. – Consolidating information – Sharing information – Next steps…written summary of interview, “Thank you for your time”, leave resources (e.g., brochures)

and give contact information




Activity Preparing for the Assessment Interview

Intent: To increase participants’ awareness of the importance of intentionally incorporating the assessment interviewing skills of beginning, conducting, and concluding into their assessment interview process.


Format: Pairs

Materials: Participant’s worksheet and “Preparing for the Assessment Interview” text in the workbook.

Facilitator Instructions: Ask participants to read “Preparing for the Assessment “ in the participant’s workbook.

– Participants will take 15 minutes to write down what they might say to a client in an assessment interview in the following phases: beginning, conducting and concluding.

– In the next 15 minutes, they will pair off with another participant to present and practice their beginning, conducting and concluding statements. Reverse.

Beginning, Conducting and Concluding an Assessment Interview The following tables appear in the participant’s workbook for the Preparing for the Assessment Interview exercise.

Record what you would say to a client in the community as you begin, conduct and conclude the assessment process.

Beginning: Ensure the orienting statement includes the following: Purpose, key components, benefits, steps in completion and role of the assessor and the client in the completion of the common assessment.

Conducting: Record engaging and listening strategies used to conduct the assessment interview.

Concluding: Affirm the client’s understanding of the assessment completed and the next steps (actions and referrals).

Debrief Questions: “What have you learned from the assessment interview process?” “What have you become aware of?” “How has this session influenced your next steps?”




Activity Preparing for the Assessment (Part II): Setting the Tone To begin thinking about the assessment interview process, participants will review a list of strategies created by health care workers who do assessments in the community. The list is located in the workbook, and participants are asked to reflect whether the strategies could be used at the beginning, conducting or concluding stage of an interview.


Materials: Participant’s workbook, pen

Intent: To give the participant the opportunity to reflect on setting the appropriate tone for the assessment process using strategies appropriate for the various stages of the interview. Participants will have the opportunity to acknowledge and reflect that each of these tips can be used in all three phases.

Facilitator Instructions: In a large group, discuss the strategies listed in the table below. Have the group reflect on the appropriate time to use them in the interview process.

Debrief: Debrief as you are walking through the exercise with the large group.

Tip Beginning Conducting Concluding Involve the client as a full partner in the assessment conversation.

Start the assessment conversation from where the client is at.

Empower clients and allow them to forgo any question; give clients a choice not to answer the question and reassure them that by not answering it won’t affect their service.

Look for opportunities to affirm the positive attributes of the client…their ability to overcome difficulty, their resiliency.

To successfully engage a client in the assessment process and the resulting care plan, the client must believe that the assessor is willing to work on goals important to them.

Where possible, most assessment information is collected from the client directly.

Review the assessment process, clarify questions and discuss next steps.

Comprehensive assessments convey care and concern, which in turn, encourages clients to become increasingly open and trusting.

Our clients deserve a thoughtful approach.




Tip Beginning Conducting Concluding When thinking of the value of assessments, remember that none of us would welcome a dentist who worked without x-rays.

Assessors should convey warmth and acceptance when assessing clients. Communicating an expectation that the assessor can be helpful in assisting the client reach their stated goals.

Establish the best possible environment for the assessment.

Listen to and value the client’s opinions, even if these run counter to your values.

Be open-minded and prepared to learn.

Take time and build trust and rapport with the client whenever possible.

Balance all perspectives and clarify understanding at the end of the conversation. Then, agree on the next steps forward, including actions and referrals.




The Challenging Assessment

What About the Challenging Assessment? When clients try to navigate through an unfamiliar health care system, they may lose patience with us, and they may seem demanding. The responsibility of the assessor is to guide those clients through the system and hopefully bring their expectations into line with our capabilities.

Sometimes an empowered client is viewed as difficult. It is the responsibility of the assessor to clarify issues where possible and to re-channel their energy.

Following are helpful suggestions: When asked a difficult question, or when the client disagrees with a point, avoid becoming defensive. Clarify the client’s issue or concern and respond as clearly, honestly and objectively as possible. Ask for more details from the client about what they would like to know. Begin your response by confirming points on which views are similar. If you discover you have made a mistake, admit your error. If you are reacting strongly to a client’s personal disclosure (or if you are disturbed by the client’s behavior),

find an opportunity to speak with your clinical supervisor or trusted colleague about your experience as soon as possible.

Understand what the presenting distraction is and try to remediate that prior to moving on with the assessment (you need to recognize there may be times when you cannot move forward and completion of the assessment will need to be later).

If you have an external relationship with the client, it is important to separate the personal from the professional relationship bearing in mind legislation pertaining to privacy, confidentiality and consent (PHIPA), etc.




Activity Follow Up on Assessment Strengths and Challenges Exercise Duration: Approximately 20 minutes

Format: Small groups

Intent: To revisit and problem solve the top 3–5 challenges identified by the participants earlier in the day (that were flip charted).

Materials Required: Helpful questions for assessors document, flip chart, markers, sticky notes with a challenge so that each group knows what challenge they are working on.

Facilitation Instructions: “Let’s reflect on the challenges identified earlier today…” The facilitator will ask participants to divide into small groups of 3 or 4 participants. The facilitator will assign a challenge as identified earlier in the day to each group. The facilitator will ask each group to problem solve and be prepared to share their strategies for the

challenging assessment area they were assigned. Participants have 10 minutes to problem solve.

Debrief: The facilitator will ask each group to present back the strategies on dealing with the identified challenging

areas. The facilitator will work through each challenge and ask thoughtful questions to expand on ideas as

necessary and write solutions on a flip chart. At the faciltator’s discretion, he/she can encourage participants to take note of especially helpful ideas in their

workbook, or he/she can offer to type up and share these solutions with the participants via email after the session.




Benefits of a Common Assessment

Client: Assesses needs, strengths and preferences Assists with accessing the most appropriate, available services Reduces retelling of personal experience Ensures equitable, consistent access to services

Assessor: Enhances assessment skills and leads to consistency Reduces repetition and assessment misinterpretation Provides information that informs service planning

Organization: Facilitates inter-agency communication through common assessment language Enhances quality of information by having a consistent approach to collection Identifies client populations and gaps in service

Health Care System: Standardized, aggregate data can inform evidence-based decision making and planning Supports accountability and transparency

Incorporating Technology into the Assessment The use of technology in a health-related dialogue sometimes raises concerns and questions: How does the community health care worker incorporate technology into the assessment process? How does the use of technology affect the assessment interview? How do we overcome the perceived barriers that technology presents? Some clients may be more apprehensive than others. Therefore, the community health care worker needs to understand their clients, and involve them, as appropriate, with the assessment process and the software used to collect the information. They need to share the assessment data — and the reports it generates — with the client. Action plans should be created jointly with the client.

The client is regarded as an active consumer, rather than a passive recipient of health care services. The client-health care worker relationship should be viewed as a two-way one. Clients should be engaged in the assessment process and be involved in decision-making. Their perceived needs should be acknowledged and their level of satisfaction with the provided services should be appraised as well.

Health care workers should be sensitive and open, allowing discussion with clients, assuring clients that there are guided policies, which together with advanced technologies, probably provide better security for electronic medical records than the traditional paper records.




Documenting Assessment Information Using Technology Include all pertinent, “need to know” information Ensure that the information is objective, concrete and descriptive Capture comments for viewing by other service providers involved in supporting clients Comments may capture historical and collateral information Follow your HSP’s policy and procedures on documentation

As the facilitator, it’s important to stress how technology impacts documentation practices, consent and business process. Remember the purpose of documentation is to create a permanent record with objective information to capture a client’s strengths and needs that inform service planning.




Activity Putting It All Together: Role Play It is now the assessor’s turn to practice face-to-face assessment skills reviewed throughout the day. Participants will apply techniques learned and practiced in the various workshop exercises. This is a chance for participants to practice and have fun using various types of communication techniques reviewed during the workshop or to use techniques they are currently using in their practice.

Preparation: Participants will break into small groups of three and designate one person to role play the client, one to play the assessor and one to be an official observer. As a facilitator, be sure to Print role-play vignettes for participants and distribute to appropriate roles and sector participants (CSS or CMH)


Format: Groups of 3 (or more)

Intent: Participants will apply assessment strategies and communication techniques learned and practiced throughout the workshop today.

Materials: Flip charts (3) and markers. Role-play packages (different role-play scenarios/vignettes with observer, client and assessor roles). Optional – Role Play Form (See Appendix 2). Putting It All Together instructions in the participant’s workbook.

Timing: 00–05 minutes Instructions, Q&A, begin 05–50 minutes Role play takes place in small groups 50–55 minutes Small group debrief using observer notes and instructions 55–75 minutes Large group debrief capturing results

Facilitator Instructions: Distribute copies of roles…client, assessor and observer. Be mindful of the sector that participants are from. This role-play is designed to give participants the opportunity to practice the assessment skills learned today. Participants will also be given the opportunity to practice engagement techniques related to the assessment

process. Participants will get as much out of this exercise as they put in. There is a lot of expertise in the room, and some assessors have more than others. Encourage participants

to ask questions or share information that would be helpful to their peers. Everyone has a different perspective, and there is room for all of these in our group today.

Participants will be divided into groups of three. At each table, participants will choose from the three roles available: assessor, client and observer. For

groups of more than 3, there will be more than one observer. Keep in mind that there must be one assessor and one client. Not everybody can be an observer.

Instruct participants to choose their role, and read the instructions in the handout. Facilitator should circulate to each table and inquire who is playing what role. Listen for knowledge transfer

that happened throughout day to use in debrief. For example, the use of open-ended questions, creating a trusting relationship.




Budget a maximum of 45 minutes to read the instructions and to complete the role-play exercise. Debrief in one hour.

Do participants have any questions? Facilitator to circulate around and ask groups if they need any additional assistance. At the 30-minute mark, let the participants know that they have about 15 more minutes before they do their

small group debrief. At the 45-minute mark, let participants know that the large-group debrief will happen in about 15 more

minutes. Facilitate the large-group debrief by going around the room to engage each group participant in how the

exercise worked for them. You may use some of the questions below to facilitate this session.

Debrief Questions: What were some of the skills that the assessor demonstrated? From the client’s perspective, how much information did the assessor get out of you? 50% 60%? More? How do you think the assessor could have had better success? From the observer’s standpoint, how was the interaction between the client and the assessor? What questions seemed to work? Why? What questions really bombed? Why? Assessors, what would you do differently if you got the chance to do the interview over again? What are some of the lessons you’ve learned? With your varying degrees of experience and knowledge at the table, what types of feedback were you able

to comfortably give each other?




Concluding the Assessment Skills Workshop: Role of Evaluation Purpose—Evaluation helps us to learn: What worked What didn’t Where we can improve What has been learned The effectiveness of the training The satisfaction of the participants

A successful evaluation relies on understanding what you want to know. Evaluation allows facilitators to measure: Reaction—What the learner thought and felt about the training (at training). Learning—Increase in the learner’s knowledge or capability (after training). Behaviour—The way in which learners apply the learning (after training). Results—The effects on the business or environment resulting from the learner's performance (after training). Evaluation works because of the questions that are asked. Obviously a facilitator won’t know the results of the training on the day of the training, so there are some things to keep in mind: Craft evaluation type questions based on what you want to know. Ask your questions at the appropriate time. Ask the same questions multiple times to understand changes over time. Evaluation works best when: It is focused. The purpose is understood by those being evaluated. It is not overdone—too frequent or too many questions at once. The results are shared openly.

Assessment Skills Workshop Wrap-up At the end of the PowerPoint presentation, the workshop objectives should be reviewed with the participants.

“This concludes the Assessment Skills Workshop. We began with a review of the assessment process. We have talked about your interviewing experiences and how they can be integrated into the assessment interview.”

Facilitators should summarize how the day went and outline each area that was covered.

Thank the participants and take any last questions.




Appendix 1: Role-Play Vignettes




Appendix 1: Putting It All Together— Three Vignettes

CSS Vignette 1—Client Name: Alice

Age: 88 years old

Medical Status: History of arthritis and congestive heart failure

Setting: You called a CSS agency last week to request service. Someone from the agency is visiting you today to initiate an assessment. This is the first time you have requested help from an agency.

Scenario: You live alone in a two-story home with a bedroom and main bathroom upstairs. You have not been able to get

upstairs for the last few months due to arthritis and weakness. You do not use or have walking aids. You have been sleeping on the couch. There is a two-piece bathroom on the main level. You have one daughter who lives close by; she can help out only on weekends, as she works full-time and has three

teenage children. Most of your friends have moved into nursing homes or have passed away. You recently fell at home, which has impaired mobility further. You have not seen a family doctor but are thinking

about it, as you are experiencing pain in your right hip. You have a bruise on your face and arm and hope that the assessor will not notice.

You eat well but are relying more on your daughter to assist with meal preparation and the purchase of groceries. You are on several medications for arthritis and a heart condition and are able to pour medications.

You are cognitively intact. You are irritated easily and you are known for being demanding at times. You are very hard of hearing (you may wish to play this up well by not hearing and misinterpreting information given to you).

You are adamant that you require a homemaker immediately for bathing and housework and are very persistent about what you want. You want to continue living at home…no one is going to force you out of your home!

Feel free to add any other characteristics to your profile to colour the scenario.

As a client, read the scenario that you have been given and include as much as you can in the conversation with the assessor. Observe the communication techniques that the assessor uses and note which techniques are easy to respond to and which techniques make you uncomfortable.

Non-Verbal Communication Techniques Used Comments

Verbal Communication Techniques Used Comments




CSS Vignette 1—Assessor You are an assessor. Use the Role Play Form (Appendix 2) provided in this package as a generic assessment. Your focus is to practice and use communication skills discussed in the workshop, not to ensure you collect all the necessary information for a complete assessment. You have 30 minutes to perform your assessment.

When you arrive at Alice’s home, you find the following: A very frail 88-year-old woman answers the door. She seems to be walking with a noticeable limp. She walks without mobility aids, but is holding onto the wall and furniture for support. You notice a bruise over her right eye, and her right arm and hand are bruised. It appears that Alice has been sleeping on the couch…linen is stacked in the corner of the room. The home is reasonably clean, but is cluttered. You sit in the living room to complete the assessment.

Your role as an assessor is to have a conversation with the client to get as much information as possible about their current situation. Choose 5 areas to explore their needs and think of some questions you might ask in advance. Review the list of verbal and non-verbal communication techniques and incorporate at least 5 in your conversation. Identify the communication techniques you used in the worksheet below.



Debrief Questions Which technique(s) did you feel comfortable using? Why?

Which technique(s) did you not feel comfortable using? Why?




CSS Vignette 1—Observer Your role as observer is simply to record the interactions between the assessor and the client.

Do not judge any observations as being good or bad, just record what you have observed.

Communication Skills Observations Beginning the interview

Conducting the interview

Concluding the interview

Nonverbal communication skills observed:

Verbal communication skills observed:

Communication challenges presented by the client:

How did the assessor deal with any communication challenges presented?

Client response/reaction to assessor’s actions?

How did the client feel at the end of the assessment? Did she feel listened to, felt her needs were heard and met, etc.?

Other comments:




CSS Vignette 2—Client Name: Fred

Age: 52 years old

Medical Status: Alcoholic, just diagnosed with liver cancer

Setting: You called a CSS agency last week to request service. Someone from the agency is visiting you to initiate an assessment. You are not sure what services you need or want, but know you need help and support.

Scenario: Last week was the fifth time you called the CSS agency in the past two months to request help with

housework because of undiagnosed abdominal pain. Finally, someone is coming to your home to initiate an assessment for service. You really need help, but you are afraid that you will be turned down.

You just saw your doctor the week before and received the diagnosis of terminal liver cancer. He did not offer a referral for home support; however, you feel that now you really need the help. You are despondent about the diagnosis of liver cancer. You describe the location of the pain when asked, but are evasive.

You have no other medical problems. The only medication you are on is the Tylenol #3 the doctor gave you for pain, but it is not working. You have a history of alcoholism, but stopped drinking last month with AA.

You live alone and miss your buddies at the pub (you used to go every evening to meet the guys, shoot some pool and talk). Your friends are not comfortable talking about your illness, and it’s not the same any more since you don’t drink with them.

You love to talk about your past and do not stay “on topic” very well. You are evasive in your answers and are suspicious with so many questions. It is just so nice to talk with someone about your problems.

You live on the third floor of a run-down apartment building with no elevator. You don’t have the energy to cook and have been eating canned soup, toast and coffee. You have not done

laundry in weeks, and it is piling up. You are becoming unsteady on your feet and are afraid to get into the shower. You are divorced and all your family members have alienated you because of your past alcoholism. Feel free to add any other characteristics to your profile to colour the scenario.







CSS Vignette 2—Assessor You are an assessor. You are visiting a 52-year-old man that has called five times over the last two months to request service. The client reports that he was diagnosed with liver cancer last week. You suspect he is an alcoholic, but he never seems overtly drunk on the phone so you are never quite sure. Use the Role Play Form (Appendix 2) provided in this package as a generic assessment. Your focus is to practice and use communication skills discussed in the workshop, not to ensure you collect all the necessary data for a complete assessment. You have 30 minutes to perform your assessment.

When you arrive at Fred’s apartment, you find the following: Fred is a 52-year-old man who looks 10 years older than his age. He is noticeably jaundiced with a distended

abdomen. He appears very weak, holding onto the wall and furniture for support when walking. You check out the bathroom and note that there aren’t any aids to daily living.

He appears unkempt, his clothes are soiled and his hair needs washing. The kitchen is untidy with empty soup cans on the counter.

You sit in the living room to complete the assessment. Fred sits on a chair, but you notice that he has difficulty transferring out of it when he goes to answer the phone.




Debrief Questions Which technique(s) did you feel comfortable using? Why? Which technique(s) did you not feel comfortable using? Why?




CSS Vignette 2—Observer Your role as observer is simply to record the interactions between the assessor and the client. Do not judge any observations as being good or bad just record what you have observed.










Other comments:




CSS Vignette 3—Client Name: Mary

Age: 31 years old

Medical status: New diagnosis of multiple sclerosis, but no other problems.

Setting: Your doctor initiated the referral to the CSS agency last week to request service. Someone from the agency is visiting you today to initiate an assessment.

Scenario: You live at home with your husband and two children, ages three and five years. Your husband works long

hours and provides minimal assistance. He is not available for child care. You have been working full time as a salesperson traveling around your local area; however, the doctor has

now told you that you should not be driving. You recently lost most of your vision; however, you are hopeful it will return with medication. You have mobility

problems with falls, poor balance, weakness in arms and hands; however, you are walking independently. You dress in exercise outfits because they are easy to manage. Most of your own family live out of town, but one sister lives close by. You see your sister every day, but you

are concerned about becoming a burden to her…your sister has her own life… a new boyfriend, a new job and a new apartment downtown. Your sister has been helping you with a bath a few times a week. You have no bathroom equipment, and it is becoming hard for your sister to get you out of the tub on her own.

You are quite depressed, and you may be teary if the right question is asked or if you are pressured into an answer. You really do not want to talk and just want to be left alone. You know you will need help at home and will accept any offer of assistance, but you are very private and don’t like talking about yourself or the problems you will be facing.

All you can think of right now is that you cannot see to drive, are worried about the kids and that you will not be able to return to your job right now. This will result in a large reduction of income.

Feel free to add any other characteristics to your profile to colour the scenario.







CSS Vignette 3—Assessor You are an assessor. You are visiting Mary, a 31-year-old woman, recently diagnosed with Multiple Sclerosis. You received the referral from her doctor to assess Mary for in-home services. Use the Role Play Form (Appendix 2) provided in this package as a generic assessment. Your focus is to practice and use communication skills discussed in the workshop not to ensure you collect all the necessary data for a complete assessment. You have 30 minutes to perform your assessment.

When you arrive at Mary’s home, you find the following: Mary lives in a single family dwelling with 5 stairs leading up to the front door. Mary answers the door. She does not use mobility aids, but holds onto furniture for support. Mary moves around the room, avoids tripping on the toys on the floor. Mary is dressed appropriately in a track suit and running shoes. She appears well groomed. You sit in the living room to complete the assessment. The home is clean and tidy with a few toys on the floor. Mary seems to be having difficulty reading the pamphlet that you gave her.









CSS Vignette 3—Observer Your role as observer is simply to record the interactions between the assessor and the client.

Do not judge any observations as being good or bad just observe and record what you have observed.










Other comments:




CMH Vignette 1—Client Name: Alice

Age: 23 years old

Background: First Nations

Setting: The Meeting Place, a centre

Scenario: You are homeless, hungry, and have no access to laundry or shower facilities. You lived in a group home until you were 16. You talk about feeling down and sad. You have a history of abuse. You heard that this centre was a “great place to hangout” . You heard that other Aboriginal people came to this centre. You are undernourished and you are underweight. Your biological parents live on reserve in Northern Ontario. Feel free to add any other characteristics to your profile to colour the scenario. As a client, read the scenario that you have been given and include as much as you can in the conversation with the assessor. Observe the communication techniques that the assessor uses and note which techniques are easy to respond to and which techniques make you uncomfortable.






CMH Vignette 1—Assessor You are an assessor. You are meeting with Alice, a 23-year-old, First Nations, underweight, homeless woman at your centre. Use the Role Play Form (Appendix 2) provided in this package as a generic assessment. Your focus is to practice and use communication skills discussed in the workshop not to ensure you collect all the necessary data for a complete assessment. You have 30 minutes to perform your assessment.









CMH Vignette 1—Observer

Your role as observer is simply to record the interactions between the assessor and the client. Do not judge any observations as being good or bad just observe and record what you have observed.










Other comments:




CMH Vignette 2—Client

Name: Bill

Age: 45 years old

Setting: Tim Horton’s

Scenario: You live at home with your aging mother. You do not have friends and you do not go out much. You find yourself drinking and smoking a lot and not eating. You have had thoughts of suicide. Your cousin sets up a meeting at Tim Horton’s with a support worker. You experience chronic shortness of breath and persistent cough. Feel free to add any other characteristics to your profile to colour the scenario. As a client, read the scenario that you have been given and include as much as you can in the conversation with the assessor. Observe the communication techniques that the assessor uses and note which techniques are easy to respond to and which techniques make you uncomfortable.






CMH Vignette 2—Assessor You are an assessor. You are meeting with Bill, a 45 year old man who lives with his aging mother, at the neighbourhood Tim Horton’s. Bill’s cousin set up this meeting. Bill is showing signs of depression. Use the Role Play Form (Appendix 2) provided in this package as a generic assessment. Your focus is to practice and use communication skills discussed in the workshop not to ensure you collect all the necessary data for a complete assessment. You have 30 minutes to perform your assessment.




















Other comments:




CMH Vignette 3—Client

Name: Maria

Age: 37 years old

Setting: A shelter

Scenario: You have no Canadian status. You have no ID or money. You have been sleeping at various shelters. You believe that your food is being poisoned. Feel free to add any other characteristics to your profile to colour the scenario. As a client, read the scenario that you have been given and include as much as you can in the conversation with the assessor. Observe the communication techniques that the assessor uses and note which techniques are easy to respond to and which techniques make you uncomfortable.






CMH Vignette 3—Assessor You are an assessor. You are meeting with Maria, a 37-year-old woman at the shelter you work at. Maria has no identification, money, and no Canadian status. Use the assessment package provided to get to know Maria better. Your focus is to practice and use communication skills discussed in the workshop not to ensure you collect all the necessary data for a complete assessment. You have 30 minutes to perform your assessment.




















Other comments:




Appendix 2: Role Play Form Assessment Domain Assessor Notes

Needs

Strengths

Supports Currently in Place

Supports Required

Additional Assessment Areas (Physical, Cognitive/Mood, Mental Health, Emotional, Spiritual)

engaging clients in the assessment process for …

Documents