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.
Assignment due. 20/11/02. Introduction. 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)
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 and 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.