Assignment. Describe the process of assessment of a child or adult in care with a psychological disorder. In your answer refer to the process of both informal and formal assessment, clearly addressing the issue of problem definition, the use of observation, interview, psychological testing, and the recording and sharing of information. Discuss the role of the social care worker in this process. Consider the aims of the assessment process and any difficulties that might arise in achieving these. Demonstrate your understanding by illustrating with examples from your own experience. please do not redistribute this hypothesis. We work very hard to create this website, and we trust our visitors to respect it for the good of other students. Please, do not circulate this hypothesis elsewhere on the internet. Anybody found doing so will be permanently banned.
The care worker plays an important role both pre and post assessment. The assessment process is complex and involves many forms of assessment tools, such as interview, observation and psychological testing. The recording and sharing of information is necessary to ensure continuity of care.
Psychological assessment is the process of collecting and interpreting information that will be used to understand another person. There are three primary goals that guide most assessment procedures, making predictions, planning interventions, and evaluating interventions. Assessment is also commonly used to evaluate the likelihood that a particular form of treatment will be helpful for a specific patient, and to provide guideposts by which the effectiveness of treatment programmes can be measured. Different assessment procedures are likely to be employed for different purposes. Those that are useful in one situation may not be helpful in another. (Oltmanns et al 1995, p128) Since assessments play a vital role in determining the care plan or treatment programme it is essential that they measure what they are intended to measure and that the scores accurately reflect the clients' knowledge and skills, therefore for a test to be useful there must be both reliability and validity. These concepts are extremely complex. However in the most general sense a reliable test is one that yields consistent results from one time and place to another, a valid is one that measures what it was designed to measure. (Wade and Tavris 1993 p50) cal1966, elsewhere on the internet. Anybody found doing so will be permanently banned.
I currently work in a secure centre for boys whose ages range from twelve to sixteen years. These boys are extremely damaged and are generally regarded as amongst the most disturbed children in the country. Upon admittance each boy is allocated two co-keyworkers whose function in the initial stage is to ensure the primary needs of the boy are catered for, this of course is extended to compiling a care plan to meet the individual needs of the clients. To develop a meaningful care plan each boy undergoes an assessment, which is normally carried out over a period of weeks through meetings with the psychologist assigned to the centre. There is significant input expected from the care workers particularly the keyworkers.
Following admittance a Daily Report Log is maintained on each boy. The care staff record details of the boys interactions with staff and peers during various periods of the day, mornings, afternoons, evenings, and after bedtime. The positive side of behaviour is regarded as important as the negative behaviours that can be exhibited during the course of a day. Some the areas monitored are for example, ability to concentrate on a simple task such as tidying his room, interaction with peers, social skills, mealtimes, bedwetting, temper tantrums, interfering with property belonging to other boys, self-mutilation, insistence on sameness, such as routines or object placement, and so on. This form of observation and recording is an important part of the overall assessment procedure because it is carried out in an informal manner thus not pressurising the client to " perform". Careful record keeping ensures accuracy and allows different observers to crosscheck their observations. Crosschecking is necessary to make sure the observations are reliable, or consistent, from one person to another. However, it does not tell us what caused the behaviour. (Wade and Tavris 1993, p47)
You will note from the previous paragraph that the gathering of information which is so important to enable the psychologist identify the clients problems start immediately. As the boy settles into his new environment and feels safe and secure the process assessment continues. The use of interview by the care worker can find out a lot about a client. This is carried out in a conversational or unstructured manner. It is a simple type interview but very individualized to the client and generally flows along. The client may reveal some family background, give details of his likes andcofg fgr sefgfgw orfg fgk infg fofg fg.
dislikes, how he gets on with parent/s, why he has dropped out of school, and so on. When the psychologist visits the unit he also carries out an informal interview and this usually takes the form of a conversation while playing a game of snooker, or a walk around the grounds. Clinicians, recognise the importance of establishing rapport with their clients. (Davison and Neale 2001 p79)
The assessment interviews vary with regard to the amount of structure that is imposed by the interviewer; some are relatively open-ended and non-directive. In this type of interview the psychologist follows the train of thought supplied by the client. In contrast to this open-ended style some interviews follow a specific question and answer format. The structured interview is one where the questions are set out in a prescribed fashion for the interviewer. (Davison and Neale, 2001, p80) The aim in this instance is to elicit the information necessary to arrive at a diagnosis or a more complete description of the presenting symptoms. As an example I will consider the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). A list of questions is presented and the interviewer is required to make a rating from 0-4 indicating the persons level of distress or impairment. The composite rating---the total across all the items in the scale---can be used as an index of the severity of the disorder. (Oltmanns and Emery, 1995, p131). The structured interview provides a systematic framework for the collection of important diagnostic information, because for example the client may not respond favourably to the psychologist during interview and it is also impossible Visit
to specify in advance all the questions that should be asked in a non-structured interview.
Sometimes psychological tests are necessary. Psychological tests are standardized procedures to measure a person's performance on a particular task or to assess his or her personality. If the results of a diagnostic interview are inconclusive psychological tests can provide information that can be used in a supplementary way to arrive at a diagnosis (Davison and Neale, 2001 p80) it is similar to a structured interview in that it asks the same questions of each person and the answers are usually given in a format that can easily be scored. Tests such as the Minnesota Multiphasic Personality Inventory for Adolescents (MMPI/A), the Thematic Apperception Test (TAT) and the Rorschach Inkblot Test are commonly used in this area. The MMPI/A test was designed to aid in diagnosing a number of personality disturbances. In contrast to MMPI the Rorschach test is psychoanalytic and is looking at inner conflict. When analysing TAT the psychologist is looking for recurrent themes that may reveal a sense of loss or anger. Marx theorised cal1966's structuralism theory.
The purpose of the assessment process is to diagnose, and to find the best treatment for a disorder and to do this the problem it must be classified correctly. The official system used by mental health professionals is the Diagnostic and Statistical Manual of Mental Disorders. (DSM -IV). The main feature of this system is the use of multiaxial classification whereby each patient is rated on five different scales or axes, which are,
(1) All diagnostic categories except personality disorders and mental retardation.
(2) Personality disorders and mental retardation.
(3) . General medical conditions.
(4) Psychosocial and environmental problems.
(5) Global assessment of functioning. (GAF)
(Davison and Neale, 2001 p62)
Two are concerned with diagnostic categories, and the other three provide for the collection of additional relevant information The rationale for this approach hinges on the recognition that the management of individual cases depends on a consideration of several important dimensions beyond specific symptoms. These supplementary factors include the environment in which the patient is living, aspects of the patient's health that might affect psychological functions, and fluctuations in the overall level of the patient's adjustment. (Oltmanns and Emery 1995, p116)
Following the assessment procedure a case conference is convened and is attended by all relevant professionals associated with the boy. The psychologist's recommendations are discussed and an individual care plan is drawn up for the boy. Back on the unit all care staff are made aware of the assessment findings and what we need to be doing for the boy. This is important to ensure that there is continuity and a consistence in approach by the different teams.
It is usual for some boys not to co-operate at all in the assessment or even meet with the psychologist. Their main fear is that everyone will know their business. A client has the right to confidentiality and there is an ethical obligation not to reveal private communications between client and psychologist. The clients right to confidentiality,
however is not absolute. Moreover, the clients secret is often shared with other professionals within the agency and in other agencies, the obligation (to preserve confidentiality) then binds all equally. (Biestek, 1983, p121)
Psychological assessment is the process of gathering and interpreting information that will be used to understand another person. Care plans are put into place and constantly evaluated. The process of assessment is a complex one involving both carer and psychologist. The interviewer decides upon the structure of an interview, and the interview may be supplemented by various psychological tests. Recommendations and care plans are shared with other professionals.
Baird, K, Lecture Notes, 23/10/02
Biestek, F.P. (1983) The Casework Relationship, Allen and Unwin Ltd, London.
Davison, G.C. Neale, J.M. (2001) Abnormal Psychology, 8th edition. John Wiley and Sons, Inc, U.S.A.
Oltmanns, T.F. Emery, R.E. (1995), Abnormal Psychology. Prentice Hall, Englewood Cliffs.N.J 07632.
Wade, C, Tavris, C, (1993) Psychology Third Edition. HarperCollins College Publishers, New York.