Tuesday, November 16, 2010

Assessment Indicators, Components and Characteristics

Assessment Indicators, Components and Characteristics

Assessment is the process of collecting data; analyzing the nature, causes and triggers of client issues and problems; identifying strengths; reviewing the progression of the clients context; synthesizing the clients relevant data; and formulating an intervention or action plan accordingly. Components of the assessment will be driven based on the situation and may include different information based on the situation.

The components of good practice are thorough knowledge, social work values, professional ethics, proficient skills and complete process. Within a good practice milieu, one has the ability to conduct meaningful assessment. Assessment must be functional to the setting and context of the individual, family or group. Necessary components are: how the client came to be referred (self-referral, court-referred, urged by family member), how the client identifies the problem(s) or issues(s), how others view the problem(s) or issues(s), client system strengths and weaknesses, indicators of abuse and neglect, indicators of dangers to self or others, indicators of crisis or resiliency for coping with crises, social history, appropriate collateral data, and any applicable assessment protocols (i.e. Structured Clinical Interview for the DSM-IV Axis I (SCID-I) or the SCID-II) or instruments (i.e. diagnosis specific scales such as a depression inventory or post-traumatic stress inventory, the NEO Personality Inventory-Revised or the OMNI-IV for personality disorder assessment).

Assessments should be both valid and reliable. Valid assessments are ones that measure and assess what is intended to be measured and assessed. For the most valid assessment, several tools are used to assess what is going on with the client. If a client is referred for depression, a valid assessment requires more than simply reviewing the symptoms present in the DSM-IV, though this may validate some symptoms. Increasing validity might include conducting a biopsychosocial assessment, a social history, a SCID-I, a depression scale and getting collateral information from a family member. Determining validity in the field of mental health is more difficult than in other areas of science, so being diligent, as is called for in our professional ethics and values, is necessary.

For an assessment to be reliable, it must be consistent in its outcome. Therefore, the use of non-standardized instruments in assessing for depression is not appropriate as it may lead to a diagnosis that is also not reliable, meaning that another professional would not confirm the diagnosis if they conducted a full clinical assessment using valid and reliable protocols and measures. While time and financial constraints may be present and necessarily limit the tools used during assessment, sufficient assessment components need to be present that are current in the literature and research, applicable to the setting and are well versed by the assessor.

The person conducting the assessment must also be familiar with the population served. While proficiency in assessment techniques is required, sufficient nuances are present in populations that call for unique knowledge and understanding to adequately apply professional assessment tool and standards. For example, someone not accustomed to working with a patient who has lost a limb may believe the individual is exhibiting the characteristic of a psychosis when complaining of pain in the missing limb, a occurrence commonly referred to as phantom pain that is well within the norm of this condition. Simple book knowledge of diagnostic characteristics is not sufficient to be proficient in diagnosing many populations because of issues specific to that population. The uniqueness may be culturally (Hispanic youth not making eye contact being mistaken for inattentiveness or disrespect), medically (newly diagnosed cancer patient appearing to have clinical depression or anxiety), experientially (war veteran back 6-weeks from duty making normal adjustments diagnosed with Obsessive-Compulsive Personality Disorder), spiritually (need to have a priest give Last Rites), or a variety of other issues.

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