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.

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

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)

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

Adequacy of Client’s Environments.

A physical environment that is adequate, is stable, and fosters health and safety (this includes housing as well as surroundings that are free of toxins and other health risks)
Adequate social support systems (e.g., family, relatives, friends, neighbors, organized groups)
Affiliation with a meaningful and responsive faith community
Access to timely, appropriate, affordable health care (including vaccinations, physicians, dentists, medications, and nursing homes)
Access to safe, reliable, affordable child and elder care services
Access to recreational facilities
Transportation—to work, socialize, utilize resources, and exercise rights as a citizen
Adequate housing that provides ample space, sanitation, privacy, and safety from hazards and pollution (both air and noise)
Responsive police and fire protection and a reasonable degree of security
Safe and healthful work conditions
Sufficient financial resources to purchase essential resources (e.g., food, clothing, housing)
Adequate nutritional intake
Predictable living arrangements with caring others (especially for children)
Opportunities for education and self-fulfillment
Access to legal assistance
Employment opportunities

Intrapersonal Functioning

Biophysical Functioning
- Physical characteristics and presentation
- Physical health
- Use and abuse of medications, alcohol, and drugs
- Alcohol use and abuse
- Use and abuse of other substances
- Dual diagnosis: comorbid addictive and mental disorders
Cognitive/Perceptual Functioning
- Intellectual functioning
- Judgment
- Reality testing
- Coherence
- Cognitive flexibility
- Values
- Misconceptions
- Self-concept
- Assessing thought disorders
Affective Functioning
- Emotional control
- Range of emotions
- Appropriateness of affect
- Assessing affective disorders
- Bipolar disorder
- Major depressive disorder
- Suicidal risk
- Depression and suicidal risk with children, adolescents, and older adults
Behavioral Functioning
- Excesses
- Risk of violence
- Deficiencies
Motivation

Assessing Aggression

(Hepworth, et al., 2017)

(Adapted from Houston-Vega, Nuehring, & Daguio, 1997, pp. 97–101)

Personal history: Child abuse or neglect; early exposure to violence in the family; problems at school, including threats, fights, or assaults on teachers; antisocial behavior; learning disabilities, ADHD, low IQ, head injury, or other physical problems
Interpersonal relationships and social supports: Client’s attitude toward people in general; how the client interacts with the practitioner; if the client has close friendships; how the client relates to members of the opposite sex; recent changes in relationships; difficulties with social interaction
Psychological factors: Active substance use or abuse; manic phase of bipolar disorder; acute psychosis in paranoid schizophrenia; antisocial, borderline, or paranoid personality disorder; low empathy, impulsivity, intermittent explosive disorder, and inability to delay gratification
Physical conditions: Intoxication; temporal lobe epilepsy; dementia, delirium; history of head trauma
History of violence: How long has the client been getting into fights? How often? How badly has the client ever hurt someone? Does the client have a criminal record? Past hospitalization because of violent behavior?
Current threats and plans of violence: Is the client currently angry at anyone? Is there anyone the client would like to hurt or kill? Where is this person now? Does the client have access to a weapon? How would the client carry out the threat? Where?
Current crisis and situation: Current mood and behavior of the client; memory difficulty; poor concentration; poor coordination; exaggerated preoccupation with sexual thoughts and fantasies; nonadherence to medication; recent release from incarceration

Biopsychosocial Assessments

(Ross, 2000)

Identifying information (e.g., name, age, referral source, brief overview of the presenting problem)
A history of the present circumstances (i.e., the presenting problem, symptoms)
The past psychiatric and medical history of the client and the client’s family (e.g., injuries, operations, medical conditions, medication, ongoing medical treatment)
The client’s social history (e.g., overview of client’s childhood, family structure, living situation, employment and employment history, educational history, hobbies, daily routine, religious or spiritual preferences, friends, past trauma, substance use)
A mental status exam (see Figure 9-2, p. 235) and DSM-5 diagnosis
A formulation (e.g., a statement that summarizes and synthesizes the most important aspects of the case to create a story of the client and his or her past and presenting problems)
For children and adolescents, a brief overview of developmental milestones may be included, addressing the age at which he/she began crawling, walking, talking, toilet training, and so on.