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PSA6669 - SECTION 2: INTRODUCTION

 

A psychosocial assessment has no specifically defined parameters (Jordan & Franklin, 2003). However, before the problem identification, before the goal setting, before the intervention, there needs to be some organized process or system of gathering information related to the person’s history, strengths, problems and challenges, resources, and future plans. This process is termed Psychosocial Assessment.

Psychosocial refers to the personal, biological, cultural, psychological, social, cognitive, functional and spiritual aspects of an individual.

Assessment is a systematic process of collecting information and monitoring progress. [Levine, ER (2002). Glossary. In AR Roberts & GJ Greene (Eds), Social Workers desk reference(pg. 830).New York: Oxford University Press].

This course will help you become familiar with the purpose of assessment and the various methods of assessment, as well the ethical obligations of the practitioner.

This is an introductory course designed to give the student an overview of assessment methods. It is not designed to enable the student to practice a specific method without more specific training and supervision from an expert clinician.

The interaction that happens naturally in an interview - either in person or by telephone - is a resource for information that can’t be underestimated. However, in the information age, why can’t someone just fill out a form on a computer and then have the computer come up with the activities that will fix the problem?

Researchers have found that written self reports are fallible because minor changes in wording, question format or order can influence the responses. [Schwarz N (1999a) Self reports: How the questions shape the answers. American Psychologist, 54, 93-105].

In addition, there may be age related differences in self reports that can result in misleading conclusions. [Schwartz N, Park D, Knauper B (2005) Cognition, Aging and Self Reports. Grant AG 14111 from the National Institute of Aging. To appear in D. Park & N Schwartz, (eds) Cognitive Aging—A primer. 2nd Edition, Philadelphia, PA: Psychology Press].

Moreover, the presence of cross-cultural material often creates great challenges for the gathering of information through a general questionnaire. Words, ideas and concepts can have subtle differences in connotation based upon the culture in which they are presented.

Conducting face to face interviews eliminates the collection of erroneous responses due to: 1) a failure in understanding the question, 2) confusion about the time frame being addressed, and 3) cultural barriers to communication such as age and language. The interview also allows an evaluation of mood and affect, presentation of self, and communication style.

The assessment process is more than collecting information. It is more than analyzing the responses. It is a dynamic interaction between the practitioner and the individual or family unit being assessed.

The completeness and accuracy of the content will ultimately be largely dependent on how comfortable the individual is with the practitioner. The person being assessed needs to have confidence in the skill and experience of the practitioner. There needs to be a level of trust that the information being shared will result in the resolution of the current problem and/or the eventual attainment of identified personal goals.

This trust is created by a number of core features contained in the method of conducting the assessment process:

- The practitioner needs to listen and observe
- The practitioner needs to be respectful of the individual being assessed.
- The practitioner needs to be sympathetic.
- The practitioner needs to communicate clearly without being judgmental.

Finally, the practitioner needs to be able to utilize theoretical knowledge, clinical judgment and the construction of the information into a written psychosocial study or report. [Jordan C & Franklin C (2003) Clinical Assessment for Social Workers. 2nd Ed Chicago: Lycem Books pg 2].

In order to make sense out of information that is non-sequential, inconsistent, and often incomplete, it is important to have a process that effectively applies sound theoretical models of human development and behavior, as well as both cognitive and emotional intelligence. This requires that the practitioner be comfortable with analytic thinking, pattern recognition and creativity.

There will be two kinds of thinking processes that get used in assessments: inductive and deductive modes of thinking. Clinicians should understand each, know the differences between the two, and be able to apply them both in appropriate ways.

Deduction is moving from a general theory to a specific case. An example would be applying object relations theory to the assessment of a person who presents with signs and symptoms of borderline personality disorder. The clinician conducting the assessment would be on the lookout for signs of all or nothing thinking, splitting, and confused boundaries, in line with what object relations theory would predict.

This type of thinking is dependent on the validity of the theory from which the hypothesis was developed, the appropriateness of the application to the specific case and the usefulness it has to the construction of a specific intervention plan.

Case example: An individual presents with symptoms of depression. Is the depression a result of biological factors and social isolation? If the answer to either question is “no”, then it is neither logical nor consistent to treat the depression with medication and social supports. (Adapted from Bisman, CD (1999) Social work assessment: case theory construction. Families in Society, 80(3), 240-246.)

Induction is using observations of patterns of behaviors / symptoms out of which a theory is developed. To use the example just given, this would involve using observation of a representative sample of socially isolated persons who also have a history of depression to determine if medication and social supports result in any improvement in the symptoms. If actual improvement is documented, then the hypothesis is that medication and social supports will reduce depression.

By using inductive and deductive thinking processes, information obtained in the assessment interview and from other sources like documents, records, and information from family members can be put together into one of the key purposes of the assessment – developing a logical hypothesis of what elements are key to the client's challenges and potential improvements - from which an intervention plan can be developed.

In fact, it is always better to generate multiple hypotheses and to examine how the information can be interpreted in different ways. For example, borderline personality disorder can be conceptualized as a problem with object relations, but also viewed through the perspective of difficulties in developing certain affective and behavioral skills, such as emotional control and modulation, interpersonal effectiveness skills, etc.

Related to the hypothesis development is a second and connected purpose of the psychosocial assessment: to formulate a diagnosis and an intervention plan in order to improve outcomes for the individual or family system.

The practitioner needs to be cautious about their own biases and cognitive errors in developing the hypothesis and intervention plan. The practitioner should always keep the individual/family system goals at the center of any intervention plan. The assessment process is about the person being assessed - not about the practitioner.

Of particular risk for a clinician is an over-reliance on any single theory of practice. There is no one single theory of human development or human behavior. Depending on your practice setting, some theories will be more relevant than others. Practitioners need to have a broad working knowledge of a variety of theories in order to offer the individual options for interventions that are significant and pertinent. Just as “one size does NOT fit all”, no one theory or approach meets the intervention needs for all clients.

Theories mark the difference between a professionally educated practitioner and a technician. Professional practitioners with a knowledge base in theoretical models can apply this knowledge to changing circumstances and complex cases. No matter how theories are categorized, they guide practice, explain and predict, direct research and provide a basis for policy.

Theories have two functions - to explain and to predict. Theories influence the choice of interventions that would be most likely to succeed. Professionals value theory as a guide to practice. Clinical interventions should have a theoretical model that is specific to the individual being assessed, and relevant for the problems and challenges that have been identified.

Practitioners need to guard against errors of interpretation related to personal bias and lack of professional knowledge. Even though theories cannot explain all behavior, the professional who has a depth of understanding about a variety of theories does have an advantage in interpreting information obtained in the assessment process.

Practitioners need to know what theory is a good “fit” for the mission of your agency, the population served and the problems that need to be addressed. [Bennett, S (2004) ppt presentation, “Helping Students Apply Theory to Practice”, NCAAA Orientation for Field Instruction.

To illustrate the relationship between theoretical models and practice interventions, it is only necessary to explore the needs of disaster survivors. There are a variety of disasters - natural, accidental or intentional. Some are predictable like hurricanes; some are not, like mechanical failures or criminal acts.

The victims of disasters come from every educational and socio-economic level. The very young and the very old are especially vulnerable in a disaster situations because they are the least likely to be able to take care of their own needs.

All disaster survivors have one thing in common - they are no longer able to provide for themselves. The theoretical model that works best as a starting point for this population is Abraham Maslow’s Hierarchy of Needs. [Maslow A (1943) A theory of human motivation. Psychological Review, 50, 370-396].

Physiological needs are the most basic and necessary of needs. These include oxygen, water, food, shelter, clothing and a means of excreting bodily waste products. After the physiological needs, come the needs for safety and security. Stable and predictable circumstances, protection from further harm are sought by victims of disaster. Once these needs are satisfied, then the social needs become more prominent. Reconnection with family, friends and community surface and there is a need to know how others survived the disaster. Self-esteem needs come into play last.

Using this model, interventions would begin with the basic physiological needs with special attention to the very young and the very old. Providing food, shelter, clothing, medication and supplies would be the first step in helping this population. The next step would be to ensure the safety, predictability and security. This would entail setting up a system that continues to provide for the uninterrupted delivery of goods and services to ensure that the basic needs are met.

Contacting family and friends and identifying resources for rebuilding the community would be the next priority. The last intervention would be addressing the emotional reactions to the disaster. This is how a theoretical model informs decision making within an actual clinical situation.

Before moving to a discussion of the development of a clinical impression, there is one other area that warrant some examination: the use of measures in assessment.

 

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