Assessment


In their workbook on assessment produced to help people demonstrate their competence against the relevant DANOS unit, Hackland and Wright describe the role of assessment thus:
“The purpose of assessment is to establish a shared understanding of the issues that have caused someone to seek, or be referred for help, and to make appropriate decisions about how to address those issues. Assessment is not a one-off event, as issues may change over time as a result of circumstances affecting the individual or interventions provided to them.
…. the initial assessment which is carried out when someone first comes into contact with services is an important phase of assessment, because the information gathered is used as the basis for commencing treatment. The range and depth of assessment information can be extensive, so initial assessment may not be a single event. In this instance, key information needed to make clinical decisions and plan care must be focused on the initial assessment, and further data may be gathered later. It is important, however, to ensure that further data is gathered, and that all data is updated at regular intervals.”*

An event or a process

Notice that in the above definition, Hackland and Wright stress that assessment is a process rather than an event. There is a tendency to imagine that assessment is a thing done once in an hour long appointment that takes place before treatment happens.
Now it is obvious that a great deal of information may be obtained in a session like this but it must all be treated with considerable caution.
It is simply unreasonable to expect people to tell the full truth about themselves and their behaviour to a stranger until some rapport has developed and that the worker merits trust has been demonstrated.
Also, the more that people have experienced discrimination or abuse from services (and most have) the harder it will be to engage them and win the confidence that is necessary for meaningful work to take place.
A series of cultural expectations also influences what someone feels able to say. Whenever people are heard to talk about their drug use on a chat show or on the Jerry Springer kind of programme they tend to be apologetic or penitent. Sometimes this seems to be the only way that someone can discuss their drug use – this is compounded by the assumption that a service will be in some way be punitive and a logical to avoid being punished is to appear sorry for what has happened and ready to do anything that is suggested. It may only be as time passes and trust develops that the client feels safe enough to say what they really want to obtain from treatment.

Clients getting ready for the assessment.

For clients, assessment is the process of systematically deciding whether they want to allow an organisation to work with them to help address their substance use issues. They decide what information they want to share and to what extent they will be prepared to engage should services be offered
The word ‘assessment’ is not a neutral term. Everyone has had experience of being ‘assessed’ and their views based on what has happened to them in the past will determine how they prepare themselves for what is going to happen.
Being ‘assessed’ sounds a bit like an examination or a driving test – it is possible to be not good enough, to fail. ‘Maybe my problem is not serious enough.’
It also sounds a bit like a job interview – there may be a fear of being asked difficult questions designed to expose areas of (in)experience and as a consequence one might be excluded from the ‘job’ of being a client..
Most people will have been through a range of assessment or patient consultations with professionals who
  • May have been blaming or hostile towards them.
  • May not have listened to what they said.
  • Promised the earth and not delivered.
  • Minimised what was going on for them and been patronizing.
  • Disclosed information in a way that felt inappropriate and gone behind the patient’s back.
  • Hurt them physically or psychologically
Bearing in mind that people will normally only put themselves through an assessment to get something and as the assessor is a potential block towards achieving goals, they must develop strategies to get themselves through what may be a distressing experience. In other words clients must be manipulative – the situation they are placed in makes it necessary.
Common strategies include:
  • Reading up as much as possible about the problem and types of treatment. They then may present the worker with a menu of options.
  • Exaggerating certain symptoms and minimising others depending on what they think will interest the worker or service.
  • Deciding what information is the business of the assessor and may be disclosed.
  • Trying to win over and befriend the assessor.
  • Flirting.
  • Minimising the problem and telling jokes.

The role of the worker

Workers in an assessment encourage conversation with a client and ask questions to allow a client time and space to share information that is going to be relevant to their care. They will also need to consider whether their service is the appropriate one for the client, whether the eligibility criteria are met and issues of risk and need.
Workers need to:-
  • Prepare for the assessment process
  • Establish rapport with the client
  • Carry out assessment in a decent way that minimises risk.
  • Engage the client with the process
  • Complete all relevant documentation

Workers preparing for assessment

At the very least workers must be familiar with the information that the service has about the person – to be asked the same questions by yet another worker is very irritating. Results of physical investigations and referral forms may be available. There may also be an opportunity if consent has been obtained (unless in exceptional circumstances) to liaise with other workers and carers. This process of ‘triangulation’ is necessary to validate the information that will be gathered or to highlight changes in circumstances. In many cases, especially where there is risk of harm to self or other people, it is an essential part of practice. If organisational time pressures make it impractical or difficult then there may be significant chance of the system being negligent or making its workers incompetent.

Relevant learning packages

alcohol brief interventions
This one-day course examines looks at how workers can screen clients who have an alcohol problem and the kinds of support that are available.
assessment
This course looks at the core issues involved in the assessment process, - it considers the type of rapport that needs to exist with the client, the kinds of questions that may be asked and strategies to deal with issues that may cause complications.
care plans and relapse prevention
This course will provide the basic knowledge and skills required to identify how to respond to a client with an alcohol problem
difficult questions and the assessment process
This course looks at the practical skills of shaping questions in a way that gives the client the necessary information they need to decide the information they want to share in a way that feels secure for them. It looks at the context of the questions being asked and provides an opportunity to consider practical strategies to address barriers. Some of the questions may be unpleasant to answer and embarrassing to ask. Common situations that workers may have problems include: • Finding out about the client's sexual history • Asking the client to define their ethnicity • Getting someone to state their sexuality
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*Fiona Hackland and Colin Wright: Using DANOS to develop practice in the workplace workbook, Unit AF2 Carry out assessment to identify and prioritise needs (Health and Social Care Unit Number HSC339), Pavilion 2005