Client Assessment

Chapter 8
 A Joint Activity

“As a joint activity by both the social worker

and the client, assessment requires their
mutual understanding and agreement.”

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

 Social Diagnosis

“Social diagnosis is the attempt to arrive at as

exact a definition as possible of the social
situation and personality of a given client.
The gathering of evidence, or investigation,
begins the process, the critical examination
and comparison of evidence follows, and last
come its interpretation and the definition of
the social difficulty.”
Mary Richmond, Social Diagnosis, 1917
 Client Assessment

 Assessment is an ongoing process

 Dynamic

 Multidimensional

 Client assessment is a synergistic process that

begins before first contact and does not end
until the work is completed.
 The Assessment Circle
client

related
systems
worker

The assessment circle represents the interrelated nature of

the systems which interact in the assessment process.
 General Overview
 Introduction to the social work perspective
and purpose of assessment.
 Assessment skills and tools.
 Gathering and organizing assessment
information.
 Introduction to the medical model.
 Initial assessment formation.
 The DAC model.
 Theory & Conceptualization
 Assessment Constraints and
Factors of Influence
 model of practice
 agency purpose and mission
 philosophy
 agency contractual considerations
 client contractual considerations
 access
 time
 resources
 Assessment Tools
 Standardized
 Graphic representations
 Written
 Historical
 Theoretical
 Personal interaction
 Professional & paraprofessional
 Use of self
 Standardized Tools
 Standardized tests, interviews and agency forms
 standardized instruments

 Beck depression inventory

 MMPI

 Rorschach

 Intelligence tests

 Child Behavior Checklist

 ASIS

 There are many commercial tests and assessment

instruments in use. Some of these instruments must be
administered or interpreted by a licensed psychiatrist,
psychologist, or other specially trained personnel.
 Beck Depression Inventory

 The Beck Depression Inventory is both valid

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

 Take a few moments to look at the BDI.

 http://www.ibogaine.desk.nl/graphics/3639b1c_23.pdf

 Do you think that the BDI is a reasonably accurate

measurement of depression?

 Do you see any problems with this instrument that

might effect accuracy?
 The Rosenberg Scale

 The Rosenberg Scale is freely available and

in the public domain. It is another example
of a standardized tool that you can use when
working with clients.

 Rosenberg Scale
 http://www.atkinson.yorku.ca/~psyctest/rosenbrg
.pdf
 Graphic Representations
 Examples
 time line

 eco-map

 genograms

 family sculpting

 A powerful assessment tool which are frequently

constructed by social workers in collaboration with the
client.
 The process of constructing a graphical representation
frequently enhances the therapeutic relationship and is
often an enjoyable and goal directed activity for client
and worker.
 Sample
Eco-maps and
Resources

http://www.dss.mo.gov/cd
/info/cwmanual/section7/c
h1_33/sec7ch25.htm

http://www.ohiocla.com/Y
ear%205%20Revisions/ec
omap1.htm
Sample Personal Timeline
 The Chronological Timeline
Take out a sheet of paper.

 Create a chronological timeline of your life.

 Do you think that a timeline would be useful
in a client assessment?
 What are the strengths and weaknesses of a
timeline?
 Written Assessment Tools
 Written
 intake & contact forms (usually standardized

by the agency)
 worker notes (sometimes standardized by the

agency particularly for documentation

related to financial reimbursement)
 problem lists

 social history (psychosocial)

 Historical Assessment Tools
 Historical records are simply documents generated by
someone other than yourself. Historical records may, or
may not, be available to you. For example:
 Past records generated and maintained by the agency
 Records which are sent as part of a referral process
 Records which are requested, using proper release of
information protocols, by the worker or the agency. These
records take time and planning to obtain.
 Historical records are useful but must be used with
caution. Historical records can contain inaccuracies or
outdated information.
The Use of Social Work Theory In
Assessment

 The unique perspective of social work

practice is a powerful assessment tool.

 Theoretical social work perspectives

 PIE: person-in-environment

 Strengths perspective

 Systems and ecological theory

 Personal Interaction & Contact
 Your personal interaction is also a valuable
assessment tool. During each contact, even
telephone contact, you are gathering assessment
information.
 Personal interaction
 formal interventions (during regularly
scheduled meetings)
 informal contact - These are interactions which
occur when greeting the client, giving a tour of
the agency, etc. The amount varies from
setting to setting.
 Professional & Paraprofessional
Collaboration
 The information you gather from professional
personnel (physicians, nurses, teachers, psychologists,
speech therapist, etc.).
 The information you gather from paraprofessional
personnel (program or case aides, office support
personnel).
 Supervision & Peer Collaboration
 Agency liaison - personnel assigned to the client, to
your agency or both.
 This important assessment tool is sometimes
formalized into treatment teams.
 Use of Self
 These are your unique personal characteristics
and skills.
 knowledge, skills and values

 experience

 specialized knowledge or training

 intuitive and deductive reasoning

 research
 Medical Model In Assessment

 Social work is not based on a medical model.

 However, ever social worker and client interact
with systems which are based in varying
degrees on the medical model of practice.
 Medical Model: A definition
 The medical model of practice is based on
the belief that the client has an illness,
disease or dysfunction which needs to be
treated by trained professionals.
 The “patient” is first diagnosed and then
treated.
 Social Work and the Medical Model
 Social workers must coexists, interact, and even
work within systems influenced by, or even
dominated by, the medical model.
 Collaboration with the medical model is
possible but social workers must not loose their
unique perspective (person-in-environment and
holistic approach) or they cease to function as a
social worker.
 The DSM-IV

 The Diagnostic and Statistical Manual,

version four, is maintained and published by
the American Psychiatric Association.
 The manual is written from the perspective
of the medical model.
 The ICD-9CM
 The International Classification of Diseases, 9th
Revision, Clinical Modification is based on the World
Health Organization’s International Classifications of
Diseases.
 It is designed for classification of morbidity and
mortality information as well as statistical purposes.
 ICD-9CM classifications are required by Medicaid
and Medicare as well as most insurance companies.
DSM-IV and ICD-9CM classifications are roughly the
same. However, one should not be used in place of
the other.
 ICD-9CM has psychiatric disorders listed in much the
same way as the DSM-IV.
 DAC

Description, Assessment and Contract

A Social History, Initial Assessment & Contracting Model
 The DAC Social History Model

 The DAC social history model has three

major divisions:

 I. Description
 II. Initial Assessment
 III. Contract
 Description - part I
 Description
 Client Identification
 Systems:
 person (micro)

 family and household (mezzo)

 ecological (macro)

 Issues of concern
 Strengths, competencies, and resources
 Referral source and process/collateral information
 Descriptive (cont.) - Social History
 developmental  educational
 personal and family  vocational
 critical life events  recreational
 sexual  spiritual
 substance abuse  prior psychological
 medical/physical or social service
 legal interventions
 other
 Initial Assessment - Part II
 Person  Family/Household/Pri
 identity and structure mary Social Systems
 mood and emotion  identity and

 life cycle development structure

 competence  mood and emotion

 risk  life cycle

development
 Environment
 resources

 social and cultural

 Contract - Part III
 Issues  Plans
 client-identified  action plan

issues  client task and action

 worker-identified steps
issues  work task and action

 agree upon issues steps

for work  In-session task and

 Goals action steps

 Maintenance tasks

 Plans to evaluate

progress
 Written Records
 Your written notes, summaries and reports are legal
documents.
 Written work should be
 accurate

 timely

 terse

 AVOID verbose, and judgmental writing.

 Write nothing that you can not defend to your
supervisor, professional organizations, state agencies,
the legal system and the client.
 Written records can be reviewed, audited or
subpoenaed by more people than you might think.
Theory
 From Idea to Theory

 An Idea is a relatively unstructured thing.

However, ideas are the building blocks of
conceptualization and conceptualization is
the building block block of theory.
 Theories ad structure and discipline to our
ideas.
 Conceptualization

 The process of assigning words to ideas,

abstractions, and constructions of empirical
reality.
 What is a theory?
 Theories are human inventions, nets, that are
designed to catch the world.
 Karl Popper, philosopher (1988)

 In drawing patters from observations to explain

phenomena, different persons may explain the
same events with a range of theories. The theory
is not real but rather is the individual’s attempt to
explain real things. Cynthia Bisman, 1999
 Theory & Assessment

 Theory exists in an individuals overall

understanding of the world around them. Why and
how things are the way they are.

 Theory is created in the assessment process.

 Is it possible to separate the theory created in

assessment from our world view?
 Theory Building & Assessment

 Theory building is a part of the assessment

process. In theory building we develop a
conceptualization of the situation.
 Cause and effect.

 If-then propositions.