PSA6669 - SECTION 10: PSYCHOSOCIAL ASSESSMENT DATA AND PLAN DEVELOPMENT
Once sufficient information has been gathered during the psychosocial assessment process, the clinician will move to the development of a treatment plan. As a starting point in organizing this part of the assessment process, the practitioner needs to remember the importance of focusing on those issues that are important to the person being assessed.
Success in meeting goals depends upon the client’s level of engagement and level of motivation. If the person who was the subject of the psychosocial assessment process is satisfied with the meaningfulness of the intervention plan, it is likely that the person will be willing to work toward achieving the goal(s). Any suggested intervention plan will require that the person contribute and agree to the details of the plan.
It is the practitioner’s work to identify the target points that are of interest to the person and suggest activities that will result in observable results. Research suggests that there are a finite number of target points that can be utilized to construct an effective and meaningful intervention plan. Clay Graybeal offers the R.O.P.E.S. approach. [Graybeal C (2001) Strengths-based social work assessment: transforming the dominant paradigm. Families in Society: J of Contemporary Human Services, 82 (3) 233-242].
In this article, R represents resources (personal, family, social, organizational and community); O represents options (present focus, emphasis on choice, what is available that has not been tried or used); P relates to possibilities (future focus, imagination, creativity, vision, play, what have you considered but not yet tried?).
E relates to when the problem is evident (times or circumstances where the problem is more or less intense or frequent, what strategies have been used to manage the problem); S represents solutions, what is working now, what is not working, what would the person like to change). This is a direct and straight-forward approach to treatment plan development based on the information gathered in the psychosocial assessment process.
There are situations that are complicated by medical or psychological issues that may need an approach that is more comprehensive and includes an historical and prognosis time frame, as well as the current time window. The Intermed Project and the Intermed Complexity Assessment Grid is a tool that has undergone 10 years of research [Stiefel FC, Huyse FJ, Sollner W, Slaets JPJ, Lyons JS, Latour CHM, van der Wal, N, de Jongem P (2006) Med Clin N Am 90, 713-758].
These authors advocate for the integration of psychosocial co-morbidities with general medical status to improve compliance with treatment, improve quality of life, increase survival, and decrease excessive health care usage.
For persons with complex social, psychological and medical needs, these authors suggest focusing on four anchor points and three time frames. Information from the psychosocial assessment is organized within these 12 cells to quickly identify those that need immediate attention from those that require long term intervention or monitoring or no intervention at all.
In the Biologic Domain, medical issues are evaluated historically for their chronicity and clarity of diagnosis, In the Current state the severity of symptoms as well as the clarity of diagnosis is reviewed. Prognosis in this domain relates to complications and life threat. Medical conditions that might be considered life threatening would include delirium, organ failure, heart attack, uncontrolled infection or bleeding.
In the Psychologic Domain the person’s psychiatric condition is evaluated historically by identifying restrictions in coping or dysfunction. In the Current state, does the person have active psychiatric symptoms and/or are they resistive to treatment. In the Prognosis cell any mental health threat is identified, for example the risk of being a danger to self or others.
The Social Domain focuses historically on any identified restrictions in social integration or evidence of social dysfunction. In the current state, residential stability and restrictions within the social support network are categorized. In the Prognosis the person’s social vulnerability is identified.
The Health Care Domain indentifies historically the intensity of previous medical/psychiatric treatment as well as the person’s perception of their treatment experience. In the Current state, the person’s organization of care and appropriateness of referrals are evaluated. In the future Prognosis, issues with coordination of care are identified.
This type of complex organization of information from the psychosocial assessment is clearly not for everyone. But for those persons who have complex co-morbid conditions, this may be a beneficial approach. There are psychiatric disorders such as depression that have medical symptoms, just as persons with coronary artery disease and/or diabetes may also exhibit symptoms related to depression.
Any practitioner engaged in the delivery of psychosocial assessments, at minimum, should have awareness and knowledge of age specific and cultural differences and the special needs related to these differences. In addition, the practitioner should have a broad knowledge base of theories of human development and behavior, as well as diagnostic signs and symptoms - especially on how symptoms can represent more than one type of condition. The practitioner should have resources either through supervision or peer support to discuss issues related to skills, education and competency.
In order to avoid errors in professional bias in the psychosocial assessment process, the practitioner should always seek alternative explanations for the signs, symptoms and behaviors identified in the process. The practitioner needs to be mindful that the psychosocial assessment process is conducted in collaboration with the person being assessed.