General Assessment Issues
The basis for any effective social work action is effective assessment of the problem or situation. A solid understanding of assessment issues is important to the success of case work, crisis management, clinical treatment, psycho education, community organizing, new parent support, child protection services, advocacy, policy development and any other issues that may be defined. It is the key to beginning an effective relationship with a client, or starting any element of mezzo or macro practice.
The first part of the process in assessment is to determine why the client is present. The psychosocial summary should include a statement about what brought the client to the session, specifically the basis for the assessment. When the reason for the assessment is discovered, it drives who should be present for the initial meeting. For example, if parents call about a "problem child," age 7, who is "out of control," who should attend the first session? Should the entire family be present, or some subset thereof? Further, what is observed in the waiting room prior to the initial session? Is the parent engaged with the child, dismissive, agitated, pacing, on the phone? Which member of the family seems eager to be present? Who seems anxious, angry or scared?
Confidentiality must be addressed prior to the start of assessment. If notes are taken during session, be open with the client about what you are doing, such as saying "I need to have some specific information because some things may be hard for me to recall, like dates, names or events." The full parameters of what information can and cannot be kept confidential are important to provide. If insurance is being filed, it is important to make sure the client(s) understand what the insurance company can access and review or what is submitted to the company. If the client is involuntary (i.e. court ordered), make sure the client knows what is expected of them and how confidentiality relates to their status.
Often clients have curiosity about their social worker. After all, the worker is often actively engaged in the client's life and knows extensive information about the client. As a social worker, one must decide how personal questions will be addressed. This should be based on several considerations. One is agency policy. Does the agency have a policy about the disclosure of personal information with clients. Theory often drives how much information is disclosed and the meaning of the question asked by the client. Generally, it is important to understand the meaning of the question to the client. Some clients may ask a personal question because they want to know if the worker has experience in something going on in the client's life. Cultural issues may drive the client's question, perhaps wanting to learn about how a social worker from the dominant culture may relate to a client from a minority background. Other clients have a sincere curiosity about the person who is becoming a part of their life. Some clients have significant boundary issues. Most important is to understand the significance of the client's question and put the client's interests first. This does not suggest the client needs intimate details of a social worker's life, but interpersonal sharing can begin healthy role-modeling for the client. If the worker is uncomfortable sharing any personal information, the worker must negotiate that, as well. The worker can still set the tone for a positive relationship by setting a boundary that does not include sharing personal information by responding honestly, such as "I am not comfortable sharing about my personal life with you, but I want to understand what that question means to you or if you feel I can help without answering personal questions."
The timeframe for assessment may very across settings. Requirements present in a governmental agency may be different than in a non-profit agency setting or an independent practitioner's office. An inpatient unit may require assessment to go very quickly because the turn-around time for the client is fast, while a residential program may allow for assessment to be done over two or three sessions, resulting in a more in-depth assessment. The payer (i.e. insurance, private, self-pay) often dictates the limits or flexibility allowed in the assessment process.
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