PSA6669 - SECTION 11: IMPLEMENTING THE COMPREHENSIVE PSYCHOSOCIAL ASSESSMENT
A psychosocial assessment can not be considered “comprehensive” unless all aspects of the individual or family unit are included. This process is validated in theoretical models such as Ken Wilbur’s “AQUAL” theory [Wilbur, K (2000) Integral psychology: consciousness, spirit, psychology, therapy. Boston, MA: Shambhala], and empirically through the INTERMED PROJECT [Stiefel FC, et.al, Operationalizing Integrated Care on a Clinical Level: The Intermed Project. Med Clin N Am 90, 713-758] and in Kolbe Theory of action using a strength based perspective.[Kolbe K (2002) Kolbe statistical handbook: statistical analysis of Kolbe indexes. Phoenix, AZ: Kolbe Corporation.]
It is not sufficient to focus just on a person’s cognitive function and affect but also, on the individual’s mode of implementing purposeful, goal directed behavior. This element is called “conation”. [Gerdes KE and Stromwall LK (2008) Conation: a missing link in the strengths perspective. Social Work, Volume 53, Number 3, July 2008].
Usually, the psychosocial assessment begins with obtaining demographic information. This can be accomplished by self report so long as the information is validated by acceptable documentation.
This is particularly important with respect to insurance information, place of residence, employment, date of birth and emergency contact information. Copies of insurance cards, driver’s license, birth certificate, court documents related to custody issues or divorce decrees, current employment should be part of the individual’s record.
Since factors such as residence, employment and insurance can and often do change, review of this information should be conducted at least quarterly to keep the information current. This is especially important for contact information such as current phone numbers and address, insurance coverage, medication changes and emergency contacts.
The actual format of the assessment can be whatever the practitioner and the client find most useful in the identification of areas of concern and the development of relevant interventions. Sometimes, the format is dictated by the clinician's organization and the focus is on specific services offered.
Regardless of the format—narrative, standardized questionnaire, or graphic approach such as the genogram, ecogram or ecomap, it is the practitioner’s responsibility to ensure that all aspects are addressed.
A comprehensive assessment should include a review of the person’s medical, psychological, social and system (cultural, health system, environmental) status in three time frames: historical, current and future prediction.
The suggested template will allow for discovering the person’s internal experiences, observation of behavior, the person’s perceived role within their culture and how the person functions within the larger society. The manner in which a person perceives their “problems” and how they work toward resolution is based on the individual’s cognitive abilities, affect and how they act in implementing their plan.
According to Kolbe [Kolbe K (1990) Conative Connection. Pheonix, AZ: Kolbe Corporation] the manner in which a person acts is comprised of varying combinations of how information is gathered and communicated, how the information is sorted and stored, how the person addresses risks both known and unknown, and how the person engages with physical objects and spaces to achieve desired results.
The individual’s manner of action is independent of and distinct from the affective or emotional aspects of personality. They are stable and resistant to change.
Although any one of the pathways within Kolbe’s matrix can be used to problem solve, each person has their own preferred action mode. Individuals may be more successful when encouraged to use their natural pattern of action. The practitioner can identify the person’s natural manner of problem solving by discovering how the person solved problems in the past and what the person is confident about in terms of trying to resolve current problems.
In the following sections a template for a psychosocial assessment will be presented. It includes all the aspects that researchers and practitioners have identified as essential elements in the psychosocial assessment process.
The template can be used for a narrative assessment, or in conjunction with standardized or commercial products. It can also be used with graphic representations to ensure that all elements are addressed prior to development of the treatment plan.