SOWK 486 - Week 08 - Assessments

A presentation at Heritage University @ CBC Week 08 in October 2021 in Pasco, WA 99301, USA by Jacob Campbell

SOWK 486 Fall 2021 Planning: Class 08 — SOWK 486 Fall 2021 Planning: Class 08
Week 08: 10/13/21 Content: Assessments Reading: Hepworth et al. (2017) chapters eight and nine Due: A-02: Reading Quiz for chapters eight and nine is due at 5:30 PM before class via My Heritage

Agenda — Agenda
Diagnostic Assessments
Screening Tools
DSM-5
Documentation
Mini-Mental Status Exams

The Multidimensionality of Assessment — The Multidimensionality of Assessment
Assessments give a social worker the ability to “gathering information and formulating it into a coherent picture of the client and his or her circumstances” (p. 187)
When we are thinking about assessments, we generally think about them as being multidimensional.
Complex Interplay: Human problems, even those that appear to be simple at first glance—often involve a complex interplay of many factors.
Rarely do sources of problems reside solely within an individual or within that individual’s environment.
Complex Social Institutions: The multidimensionality of human problems is a consequence of the fact that human beings are social creatures who depend both on other human beings and on complex social institutions to meet their needs.
__ Person’s functioning__: Assessing the functioning of an individual entails evaluating various aspects of that person’s functioning.

Priorities in Assessment — Priorities in Assessment
Although a social worker’s assessment will be guided by the setting in which the assessment is conducted, certain priorities in assessment influence all social work settings.
Initially, three questions should be assessed in all situations:
What does the client see as his or her primary concerns or goals?
What (if any) current or impending legal mandates must the client and social worker consider?
What (if any) potentially serious health or safety concerns might require the social worker’s and client’s attention?

Ethical Considerations Regarding Clinical Work — Ethical Considerations Regarding Clinical Work
As students, and especially BA social work students, we want to discuss a little bit of the limitations of this. It should be self evident, but…
Who gives diagnoses?
[Whole Class Activity: Discussion] Who general gives diagnoses? (think about autism and who general ascribe those diagnoses)
Students role in understanding clinical practice
It’s about have a common language
In reading reports
Introduction to clinical terminology

Using the DSM — Using the DSM
The Diagnostic and Statistical Manual of Mental Disorders is a collection of diagnoses of mental disordered accompanied by the typical behaviors and symptoms you might see in a particular diagnosis.
[Discussion] How much do you know about the DSM?
[Discussion] What is the purpose of the DSM
—> Click
Common language
Billing
Research

Problems Related to the DSM — Problems Related to the DSM
While the DSM is prolific and used everywhere, there are some problems that are related to the DSM?
[Discussion] What are some of the problems people have with use of a medical model for diagnoses
Not strengths based (Graybeal, 2001)
Possible loss of personal freedom (recommendations of specific treatments)
Lifelong labeling
Variance of diagnoses among professionals (other citation)
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Graybeal, C. (2001). Strengths-based social work assessment: Transforming the dominant paradigm. Families in Society: The Journal of Contemporary Social Services, 82(3), 233-242. https://doi.org/10.1606/1044-3894.236
Shackle, E. M. (1985). Psychiatric diagnosis as an ethical problem. Journal of Medical Ethics, 11(9), 132-134. https://doi.org/10.1136/jme.11.3.132
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DSM Sections — DSM Sections
The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) is an important tool for understanding and formulating mental and emotional disorders (American Psychiatric Association, 2013b).
For each disorder, the manual uses a standardized format to present relevant information. The sections contain:
Diagnostic criteria
Subtypes/specifiers
Recording procedures
Diagnostic features
Associated features supporting diagnosis
Prevalence
Development and course
Risk and prognostic factors
Specific culture, gender, and age features
Functional consequences of the specific diagnosis
Differential diagnosis
Comorbidity

Emphasizing Strengths in Assessments — Emphasizing Strengths in Assessments
To emphasize strengths and empowerment in the assessment process, Cowger (1994) as cited in the textbook made three suggestions to social workers:
Give pre-eminence to the client’s understanding of the facts
Discover what the client wants
Assess personal and environmental strengths on multiple levels
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Cowger, C. D. (1994). Assessing client strengths: Clinical assessment for client empowerment. Social Work, 39(3), 262-268. https://doi.org/10.1093/sw/39.3.262
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Framework for Strengths in Assessment — Framework for Strengths in Assessment
From saleebey, D. (2009) The strengths perspective in social work practice (2nd ed.) Pearson Education inc: Upper Saddle River New Jersey
4 quadrants
Strengths or Resources Vs.
Deficit, Obstacle, or Challenges
And
Environmental factors (family, community) Vs.
Individual or personal factors

How Observant Are You? — How Observant Are You?
The following is a short video. So, you all have at least gotten your AA. I want to do a short little test to see how well you can count. We are going to watch a short movie clip of two teams (a black one and a white one) passing the ball. Make sure that you keep an accurate count!
[Activity] Watch the video clip
[Discussion] How many did you count? How many of you noticed the gorilla moon walking through the background?
Context is important when we think about our clients situations.

Conditions Surrounding Troubling Behaviors — Conditions Surrounding Troubling Behaviors
Assessment focuses on the conditions surrounding troubling behaviors, the conditions that reinforce the behavior, and the consequences and secondary gains that might result. Questions to address this sequence include:
When: When do you experience the behavior?
Where: Where do you experience the behavior?
Duration: How long does the behavior usually last?
Consequences: What happens immediately after the behavior occurs?
Physiological: What bodily reactions do you experience with the behavior?
Social: What do the people around you usually do when the behavior is happening?
Reinforcement: What happened after the behavior that was pleasant?

Sources of Information for Assessments — Sources of Information for Assessments
Numerous sources of information can be used individually or in combination. The following are the most common:
Background sheets or other intake forms that clients complete
Interview with clients (e.g., accounts of problems, history, views, thoughts, events, and the like)
Direct observation of nonverbal behavior
Direct observation of interaction between partners, family members, and group members
Collateral information from relatives, friends, physicians, teachers, employers, and other professionals
Tests or assessment instruments
Personal experiences of the practitioner based on direct interactions with clients

Introduction - Managing Stress - BBC — Introduction - Managing Stress - BBC
College and life is stressful. The following is a short video clip about managing stress by the BBC.
[Whole Class Activity] Watch video clip
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BBC. (2010). Managing stress - Brainsmart - BBC [Video]. YouTube. https://youtu.be/hnpQrMqDoqE
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Perceived Stress Screener (1 of 2) — Perceived Stress Screener (1 of 2)
We are going to talk some about screening tools. The Global Measure of Perceived Stress, original published by Cohen et al. in 1983, is a tool. I didn’t want to choose a tool that would be too intrusive and that might still be useful. In class, I’ve generally printed and had students complete about five different screeners to see how each of them work. Today we will just do this one.
[Whole Class Activity] Write on a sheet of paper your rating for each of the numbers (make sure to number your answer)
In the last month, how often have you been upset because of something that happened unexpectedly?
In the last month, how often have you felt that you were unable to control the important things in your life?
In the last month, how often have you felt nervous and stressed?
In the last month, how often have you felt confident about your ability to handle your personal problems?
In the last month, how often have you felt that things were going your way?
In the last month, how often have you found that you could not cope with all the things that you had to do?
In the last month, how often have you been able to control irritations in your life?
In the last month, how often have you felt that you were on top of things?
In the last month, how often have you been angered because of things that happened that were outside of your control?
In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?
For each question choose from the following alternatives: 0 - never 1 - almost never 2 - sometimes 3 - fairly often 4 - very often
Example taken from the New Hampshire Department of Employee Assistance Programs: https://das.nh.gov/wellness/Docs/Percieved%20Stress%20Scale.pdf
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Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A Global Measure of Perceived Stress. Journal of Health and Social Behavior, 24(4), 385. https://doi.org/10.2307/2136404
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Perceived Stress Screener (2 of 2) — Perceived Stress Screener (2 of 2)
Score yourself
Reverse your scores for questions 4, 5, 7, and 8. On these 4 questions, change the scores like this: 0 = 4, 1 = 3, 2 = 2, 3 = 1, 4 = 0.
Add up your scores for each item to get a total.
Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher perceived stress.
Scores ranging from 0-13 would be considered low stress.
Scores ranging from 14-26 would be considered moderate stress.
Scores ranging from 27-40 would be considered high perceived stress.
The Perceived Stress Scale is interesting and important because your perception of what is happening in your life is most important. Consider the idea that two individuals could have the exact same events and experiences in their lives for the past month. Depending on their perception, total score could put one of those individuals in the low stress category and the total score could put the second person in the high stress category
[Small Group Activity] Students will be broken up into small groups to consider their scores for the Perceived Stress Screener
How accurate was your do you feel this was
How is completing a screener useful for the worker
How is completing a screener useful for the client
[Whole Class Activity] Have discussion about how we can use screeners and why we might use them.

Examples of the Screeners - PHQ-9 - Patient Depression Questionnaire — Examples of the Screeners - PHQ-9 - Patient Depression Questionnaire
PHQ-9 - Patient Depression Questionnaire
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Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
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Examples of the Screeners - GAD-7 - Generalized Anxiety — Examples of the Screeners - GAD-7 - Generalized Anxiety
GAD-7 - Generalized Anxiety
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Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. https://doi.org/10.1001/archinte.166.10.1092
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Examples of the Screeners - GAIN-SS — Examples of the Screeners - GAIN-SS
GAIN-SS - Internalizing, externalizing, and substance abuse.
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Dennis, M. L., Chan, Y.-F., & Funk, R. R. (2006). Development and validation of the GAIN short screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. American Journal on Addictions, 15(s1), 80-91. https://doi.org/10.1080/10550490601006055
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Examples of Screener Forms Psychiatric Mental Health Nurse Practitioner — Examples of Screener Forms Psychiatric Mental Health Nurse Practitioner
Show the various tools at PMH-NP

Problem Assessment — Problem Assessment
Good practice requires social workers to use a variety of communication methods to encourage the client to tell his or her story.
Social workers’ initial contacts with clients will concentrate on…
Identifying the presenting problem
Uncovering the sources of this problem
Engaging the client in planning appropriate remedial measures.

Systems of Interaction — Systems of Interaction
A portion of the assessment should include information regarding the various systems they interact with
People commonly interact with the following systems:
The family and extended family or kinship network
The social network (friends, neighbors, etc.)
Public institutions (educational, recreational,etc.)
Personal service providers (doctor, dentist, etc.)
The faith community (religious leaders, lay ministers, etc.)

Determining Needs — Determining Needs
Determining unmet needs, then, is the first step in identifying which resources must be tapped or developed.
In determining clients’ unmet needs and wants, it is essential to consider the developmental stage of the individual, couple, or family.
[Whole Class Activity] Discuss how we asses needs along with the difference between needs and wants.

Preparation for In-Class Teach Back — Preparation for In-Class Teach Back
This assignment is going to be a part of participation in class for week 09. There are no other assignments either this week or next to have time to prepare for it.
Purpose: For students to be able to both increase knowledge around assessment and to facilitate learning for peers about what to examine in various assessments.
Task: Students will work in small groups to plan a presentation to take place during class on 10/19/20. Students will prepare a short five to 10-minute presentation to talk about what social workers should be looking for in various aspects of assessments. During class 10/12/20 students will be divided up into four groups. Each group will be assigned one of the following out of the textbook:
Suicide Risk Assessment (pp. 230-234)
Assessing Aggression (pp. 236-237)
Assessing Environmental Systems (pp. 237-241)
Assessing Biophysical Functioning (pp. 218 - 224)
Students are to prepare to share information and have a discussion with classmates about their selected area. Students may choose to create a presentation that can be completed during class. The goal is to help classmates know how to assess for the given topic and have a group discussion about the topic.
Criterion for Success: Students will show they are prepared in class on week nine to facilitate both information about their topic and have discussion with their fellow students.

How I Write My Notes — How I Write My Notes
I wanted to show how I write my notes.
Plain text
Giving basic information
TextExpander

General Components of a MSE — General Components of a MSE
The following are the general parts of a MSE
General appearance
Behavior
Thought process and content
Affect
Impulse control
Insight
Cognitive functioning
Intelligence
Reality testing
Suicidal or homicidal ideation
Judgment
[Discussion] Do we use formalized words in our documentation?
[Discussion] Mental Status Examination vs Mini Mental Status Examination

General Appearance (1 of 4) — General Appearance (1 of 4)
General appearance is one aspect that is evaluated by workers as a part of a diagnostic process.
—> Appearance
Grooming
Meticulous (too perfect)
Skillfully applied
Garish (outlandish)
Self-neglect
Dress
Immaculate (too neat)
Unconventional (odd)
Fashionable (think small town)
Physical characteristics
Outstanding features (tattoos, missing part of hand… etc)
Build (emaciated, thin, average, stocky, obese)
Important physical features
Disabilities
Posture and gait
Use of mobility device
Slumped

General Appearance (2 of 4) — General Appearance (2 of 4)
Along with the appearance is…
Attitude and Interpersonal Style
Hostility
Uncooperative
Inappropriate boundaries
Seductive
Playful
Ingratiating (what ever you say goes)
Guarded
Sullen
Passive
Manipulative
Contemptuous (superior, sneering cynical)
Demanding
Withdrawn

General Appearance (3 of 4) — General Appearance (3 of 4)
Facial expressions and psychomotor activity are both included in the general appearance of the client.
Facial expression
Bland (intense material, but looks casual)
Flat (no facial expression)
Liable (rapid changes)
Behavior and Psychomotor activity
Seated quietly (limited movement)
Hyperactive (Busy with hands and or feet)
Agitated (unable to sit still)
Combative
Awkward (Unable to manage activity)
Rigid
Mannerism (unconscious repetitive motions)
Posturing (certain postures and holds inappropriately) (think duel meaning)
Tics and twitches (involuntary movements)
Motor hyperactivity
Motor retardations (slowly)
Tension Severe akathisia (severe restlessness)
Tardive dyskinesia (Late appearing abnormal movements) (Anti-psychotic medications)
Catatonic behavior

General Appearance (4 of 4) — General Appearance (4 of 4)
Speech and language is also a part of the general appearance.
Speech and Language
Pressured
Monotonous
Emotional
Accented (slp stuff)
Impoverished
Neologisms (New words)
Aphasia (Inability to understand / produce language)
Global aphasia (Not speak, understand, write, repeat, name objects)
Broca’s aphasia (understand, but trouble expressing own thoughts)
Wernike’s aphasia: (Inability to express words - Word salad - uses bizarre / non nonsensical speech)
Dysarthria (difficulty articulating due to problems with the mechanisms that produce speech)
Perseveration (repeating verbal or motor response)
Stereotypy (constant repetition of speech or actions)

Emotions — Emotions
Reporting on emotions is an important aspect of client assessment as well.
Neurovegetative (autonomic - acting or occurring involuntarily) can be signs of depression. Neurovegetative symptoms are symptoms leading to dissociation from society as a whole.
Symptoms include physical, emotional and cognitive changes. When the symptoms combine as in depression, they work in unison to cause a further decline in the mental state of the patient. This downward spiral can be overlooked until the depression is in an extreme state.)
Mood
Euthymic (normal mood)
Expansive (improvement)
Euphoric
Anxious
Clients description
Affect (the external expression of emotion attached to ideas or mental representations of objects)
Broad (Normal range of mood)
Appropriate
Constricted (reduction in the intensity of affect, to a somewhat lesser degree than is characteristic of blunted affect)
Blunted (severe reduction in the intensity of affect; a common symptom of schizophrenic disorders)
Flat (lack of emotional expression.)
Labile (rapid changes)
Anhedonic (incapable of pleasure)
Emotional withdrawal
Full range of affect
Congruent with mood
Sleep
Initial insomnia (trouble falling asleep)
Middle insomnia (waking in the night)
Terminal insomnia (Early morning waking)
Hypersomnia (over sleeping)

Cognitive Functioning (1 or 2) — Cognitive Functioning (1 or 2)
Another area that is that of a clients cognitive functioning.
Orientation and level of consciousness
Lethargy (trouble remaining alert)
Obtundation (Difficult to arouse)
Stupor (semi-comatose)
Coma (unable to arouse)
Oriented Times Four (person, time, place, Context)
Attention and concentration
Serial 7’s (3’s, spelling word world backwards)
Memory
Registration (gaining memories)
Retention (keeping it)
Retrieval (calling it back)
Short term memory
Long term memory
Amnesia (inability to remember)
Anterograde amnesia (cannot learn new material)
Retrograde amnesia (inability recall past events)
Head Injuries (TBI)
Transient global amnesia (sudden confusion, loss of memory, disorientation… etc)

Cognitive Functioning (2 or 2) — Cognitive Functioning (2 or 2)
As well there can be…
Memory Testing
Immediate recall (digits adding one digit a time, significant if fails 5 or less digits) (think anxiety depression)
Recent memory (apple penny table)
Remote memories (information about life, major events… etc)
Ability to Abstract and Generalize
Proverbs (psychosis)
Similarities and differences (apples and oranges)
Information Intelligence
Basic facts about figures… etc
Fund of knowledge

Thoughts and Perception (1 of 3) — Thoughts and Perception (1 of 3)
Thoughts and perceptions are another area that we evaluate.
Disordered Perceptions
Illusions
Hallucinations
Depersonalization (feeling detached from self)
Dearealization (Feeling detached from what is real and not real)
Thought Content
Distortions (part of reality) (think anaxeia)
Delusions (Inappropriate idea of reality)
Paranoid delusions
Thought withdrawal (thoughts taken from one’s mind)
Thought insertion
Though broadcasting (others can hear)
Suspiciousness
Grandiose delusions
Somatic delusions (false beliefs about ones health)
Delusional guilt (falsely believing guilty)
Nihilistic delusions (meaninglessness of life)
Ideas of inference (false beliefs of what others do to him) (shooting apartment)
Ideas of reference (people are thinking about person)
Magical thinking (think about religious beliefs, cognitive level… etc)
Thought content (specify what is in the thoughts)
Bizarre behavior

Thoughts and Perception (2 of 3) — Thoughts and Perception (2 of 3)
Thought Process - Flow of Ideas (quality of associations)
Spontaneous (without asking questions)
Goal directed
Impoverished
Racing thoughts
blocking (pausing)
Circumstantial (too many irrelevant ideas)
Persevrative
Loose association (not logical)
Flight of ideas (jumping from idea to another in logical sequence)
Illogical
Incoherent
Neologism (new words)
Distractable
Clang association (Sound of word rather than idea)
Tangentiality
Overvalued (ideas might be possible, but used incorrectly)
Conceptual disorganization

Thoughts and Perception (3 of 3) — Thoughts and Perception (3 of 3)
Preoccupations
Somatic preoccupations
Obsessions
Compulsions
Phobias
Suicidality, Homicidality, Impulse control
Insight and Judgment

Jacob Campbell
@campjacob

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Week eight and nine are both about how social workers conduct assessments. After we have started building relationships with our clients, and before we can really find ways to support them we have to understand what the real problem is. We will be looking at how we do assessments. We will review examples of screening tools, talking about the DSM-5 and its uses, as well as some discussion around mini-mental status exams. Furthermore, I will show some examples of how I do documentation.