B.Figure 8.1: the Exploring, Assessing, Contracting, and Working & Evaluating Cycle

Chapter 8

Assessing

I.Assessment

A.You and the client try to make sense of the information gained in the exploration phase so you can help the client address the issue or issues that have emerged

B.Figure 8.1: The Exploring, Assessing, Contracting, and Working & Evaluating Cycle

C.Assessment involves both lifelong learning and critical thinking

II.Diagnostic and Statistical Manual (DSM-IV-TR) (American Psychiatric Association, 2000)

A.Criteria for Substance Dependence

1.Tolerance

2.Withdrawal

3.Substance often taken in larger amounts or over a longer period than was intended

4.Persistent desire or unsuccessful efforts to cut down or control substance use

5.Great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

6.Important social, occupational, or recreational activities are given up or reduced because of substance use

7.The substance use is continued despite knowledge of having a persistent or recurrent physical or physiological problem that is likely to have been caused or exacerbated by the substance

B.Criteria for Substance Abuse

1.Maladaptive pattern of substance use leading to clinically significant impairment or distress

2.Symptoms have never met the criteria for Substance Dependence for this class of substance

C.Axis III: General Medical Conditions

D.Axis IV: Psychosocial and Environmental Problems

1.Problems with primary support group

2.Problems related to the social environment

3.Educational problems

4.Occupational problems

5.Housing problems

6.Economic problems

7.Problems with access to health care services

8.Problems related to interaction with the legal system/crime

9.Other psychosocial and environmental problems

E.Appendix I—outline for a cultural formulation

F.Axis V: Psychological, Social, and Occupational Functioning

1.Global Assessment of Functioning (GAF) Scale—a client’s psychological, social, and occupational functioning may be rated on a hypothetical continuum of mental health-illness

a.Defensive Functioning Scale

b.Global Assessment of Relational Functioning (GARF) Scale

c.Social and Occupational Functioning Assessment Scale (SOFAS)

d.Outline for Cultural Formulation

e.Glossary of Culture-Bound Syndromes

III.Person-In-Environment (PIE) Classification System (Karls & Wandrei, 1994)

A.Factor I: Problems in Social Role Functioning

1.Type

2.Severity

3.Duration

4.Coping ability

B.Factor II: Environmental Problems

1.Economic/basic needs

2.Education and training

3.Judicial and legal

4.Health, safety, and social services

5.Voluntary association

6.Affectional support

C.Factor III: Mental Health Problems

D.Factor IV: Physical or Medical Conditions

E.Expect much time to pass before effective prevention or intervention services can be established for many of the social role functioning problems and environmental conditions included within the PIE Classification Manual

IV.Concepts and perspectives related to strengths, capacities, protective factors, assets, resiliencies, and solutions

A.Strengths-based model

B.Solution-focused or solution-oriented practice

C.Positive psychology—virtues and strengths are emerging in psychology as a focus for both research and practice

D.Transtheoretical Perspective (Prochaska et al., 1999)—Stages of Change

1.Precontemplation—first stage of change, characterized by ambivalence, uncertainty, disinterest, or denial

2.Contemplation—second stage, characterized by information-gathering, reflection, and analysis

3.Preparation—third stage, associated with at least two notable shifts in thinking

a.Significant increase in thinking about solutions and resolutions

b.Thoughts about the future increasingly replace those about the past and present

4.Action—fourth stage, characterized by motivation, purposefulness, activity, and optimism, you notice actual differences in the person, the situation, or aspects of both

5.Maintenance—fifth stage, represents the greatest challenge of all because it requires ongoing motivation, commitment, stamina, persistence, and follow-through

E.Health Belief Model

F.Theory of Reasoned Action

G.Theory of Planned Behavior

H.Self-efficacy

I.“Start where the client is”

V.Description, Assessment, and Contract (DAC) Format

A.Description

1.Client identification

2.Person, family and household, and community systems

a.Person system

b.Family and household system

c.Community system

3.Presenting problems/issues of concern

4.Assets, resources, and strengths

5.Social history

a.Developmental

b.Personal, familial, cultural

c.Critical events

d.Sexual

e.Alcohol and drug use

f.Medical/physical/biological

g.Legal

h.Educational

i.Employment

j.Recreational

k.Religious/spiritual

l.Prior psychological, social, or medical services

m.Other

B.Tentative assessment of the person-issue-situation

1.Problems/issues

a.Nature, duration, frequency, severity, and urgency

b.Risk and protective factors; exceptions

2.Person-and-situation

a.Personal factors

b.Situational and systemic factors

c.Motivation and readiness; stage of change

d.Challenges and obstacles

e.Risk assessment

3.Case formulation

C.Service contract

1.Problems/issues

a.Client-identified problems/issues

b.Worker-identified problems/issues

c.Agreed upon problems/issues for work

2.Service goals

3.Plans

a.Action plan/service approach

b.Client tasks/action steps

c.Worker tasks

d.In-session tasks

e.Maintenance tasks

4.Plans to evaluate progress

VI.Organizing Descriptive Information

A.Guidelines for completion of the DAC description

B.Example of a description section: Lynn B. Chase

C.Exercise 8-1: Organizing Descriptive Information

VII.Formulating a Tentative Assessment

A.Analysis—involves examining in fine detail various pieces of information about the person-issue-situation

B.Synthesis—builds on what is gained from analysis and involves assembling significant pieces of information into a coherent whole by relating them to one another and to elements of your theory, knowledge, and experience base

C.Primary purpose of assessment is to develop a coherent case formulation involving hypotheses about what and how to approach the change process

D.Evidence-based knowledge combined with theoretical understanding contributes to the development of a well-reasoned and well-supported case formulation

E.Develop a “Theory of the Case”

F.Functional analysis emerges from an understanding of the relationship of various person-and-situation factors to the identified problems/issues, and the generation of hypotheses about how best to pursue the agreed-upon goals

G.Table 8.1: Problem/Issue: Excessive Alcohol Consumption—John C.

H.Table 8.2: Functional Analysis

I.Figure 8.2: A Preliminary Concept Map—John C’s Identified Problems/Issues

J.Guidelines for completion of the DAC Assessment

K.Example of a DAC Assessment Section: Lynn B. Chase

L.Exercise 8-2: Formulating a Tentative Assessment of the Person-Issue-Situation

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