In a 3 page paper, complete the following: 

1. Utilizing two of the assessment models provided in Chapter 5 of the course text, provide a comprehensive assessment of Paula Cortez. (Please see attachment (Chapter 5) and below for Case Study)
2.  Using the Cowger article, identify at least two areas of strength in Paula’s case.(Please see attachment)
3.  Analyze the perspectives of two members of the multidisciplinary team, particularly relative to Paula’s pregnancy.
4.  Explain which model the social workers appear to be using to make their assessment.
5. Describe the potential for bias when choosing an assessment model and completing an evaluation.
6. Suggest strategies you, as Paula’s social worker, might try to avoid these biases.

Support your Assignment with specific references to the resources. Be sure to provide full APA citations for your references.

 I attached two articles that are needed for this assignment, but feel free to cite others if needed. After you read the case study on Paula you can click on the chapter 5 attachment and pick TWO assessment models and provide a comprehensive assessment of Paula Cortez. The other article I submitted (Cowger) is used for identifying at least TWO STRENGHTS in Paula’s Case.*
   
The Case of Paula Cortez

Paula Cortez Case Study
Identifying Data: Paula Cortez is a 43-year-old Catholic Hispanic female residing in New York City, NY. Paula was born in Colombia. When she was 17 years old, Paula left Colombia and moved to New York where she met David, who later became her husband. Paula and David have one son, Miguel, 20 years old. They divorced after 5 years of marriage. Paula has a five-year-old daughter, Maria, from a different relationship.
Presenting Problem: Paula has multiple medical issues, and there is concern about whether she will be able to continue to care for her youngest child, Maria. Paula has been overwhelmed, especially since she again stopped taking her medication. Paula is also concerned about the wellness of Maria.
Family Dynamics: Paula comes from a moderately well-to-do family. Paula reports suffering physical and emotional abuse at the hands of both her parents, eventually fleeing to New York to get away from the abuse. Paula comes from an authoritarian family where her role was to be “seen and not heard.” Paula states that she did not feel valued by any of her family members and reports never receiving the attention she needed. As a teenager, she realized she felt “not good enough” in her family system, which led to her leaving for New York and looking for “someone to love me.” Her parents still reside in Colombia with Paula’s two siblings.
Paula met David when she sought to purchase drugs. They married when Paula was 18 years old. The couple divorced after 5 years of marriage. Paula raised Miguel, mostly by herself, until he was 8 years old, at which time she was forced to relinquish custody due to her medical condition. Paula maintains a relationship with her son, Miguel, and her ex-husband, David. Miguel takes part in caring for his half-sister, Maria.
Paula does believe her job as a mother is to take care of Maria but is finding that more and more challenging with her physical illnesses. SOCW 6060: Social Work Theory and Practice – Paula Cortez Case Study
Employment History: Paula worked for a clothing designer, but she realized that her true passion was painting. She has a collection of more than 100 drawings and paintings, many of which track the course of her personal and emotional journey. Paula held a full-time job for a number of years before her health prevented her from working. She is now unemployed and receives Supplemental Security Disability Insurance (SSD) and Medicaid. Miguel does his best to help his mom but only works part time at a local supermarket delivering groceries.
Paula currently uses federal and state services. Paula successfully applied for WIC, the federal Supplemental Nutrition Program for Women, Infants, and Children. Given Paula’s low income, health, and Medicaid status, Paula is able to receive in-home childcare assistance through New York’s public assistance program.
Social History: Paula is bilingual, fluent in both Spanish and English. Although Paula identifies as Catholic, she does not consider religion to be a big part of her life. Paula lives with her daughter in an apartment in Queens, NY. Paula is socially isolated as she has limited contact with her family in Colombia and lacks a peer network of any kind in her neighborhood.
Five (5) years ago Paula met a man (Jesus) at a flower shop. They spoke several times. He would visit her at her apartment to have sex. Since they had an active sex life, Paula thought he was a “stand-up guy” and really liked him. She believed he would take care of her. Soon everything changed. Paula began to suspect that he was using drugs, because he had started to become controlling and demanding. He showed up at her apartment at all times of the night demanding to be let in. He called her relentlessly, and when she did not pick up the phone, he left her mean and threatening messages. Paula was fearful for her safety and thought her past behavior with drugs and sex brought on bad relationships with men and that she did not deserve better. After a couple of months, Paula realized she was pregnant. Jesus stated he did not want anything to do with the “kid” and stopped coming over, but he continued to contact and threaten Paula by phone. Paula has no contact with Jesus at this point in time due to a restraining order.
Mental Health History: Paula was diagnosed with bipolar disorder. She experiences periods of mania lasting for a couple of weeks then goes into a depressive state for months when not properly medicated. Paula has a tendency toward paranoia. Paula has a history of not complying with her psychiatric medication treatment because she does not like the way it makes her feel. She often discontinues it without telling her psychiatrist. Paula has had multiple psychiatric hospitalizations but has remained out of the hospital for the past 5 years. Paula accepts her bipolar diagnosis but demonstrates limited insight into the relationship between her symptoms and her medication.
Paula reports that when she was pregnant, she was fearful for her safety due to the baby’s father’s anger about the pregnancy. Jesus’ relentless phone calls and voicemails rattled Paula. She believed she had nowhere to turn. At that time, she became scared, slept poorly, and her paranoia increased significantly. After completing a suicide assessment 5 years ago, it was noted that Paula was decompensating quickly and was at risk of harming herself and/or her baby. Paula was involuntarily admitted to the psychiatric unit of the hospital. Paula remained on the unit for 2 weeks.
Educational History: Paula completed high school in Colombia. Paula had hoped to attend the Fashion Institute of Technology (FIT) in New York City, but getting divorced, then raising Miguel on her own interfered with her plans. Miguel attends college full time in New York City.
Medical History: Paula was diagnosed as HIV positive 15 years ago. Paula acquired AIDS three years later when she was diagnosed with a severe brain infection and a T-cell count of less than 200. Paula’s brain infection left her completely paralyzed on the right side. She lost function in her right arm and hand as well as the ability to walk. After a long stay in an acute care hospital in New York City, Paula was transferred to a skilled nursing facility (SNF) where she thought she would die. After being in the skilled nursing facility for more than a year, Paula regained the ability to walk, although she does so with a severe limp. She also regained some function in her right arm. Her right hand (her dominant hand) remains semi-paralyzed and limp. Over the course of several years, Paula taught herself to paint with her left hand and was able to return to her beloved art.
Paula began treatment for her HIV/AIDS with highly active antiretroviral therapy (HAART). Since she ran away from the family home, married and divorced a drug user, then was in an abusive relationship, Paula thought she deserved what she got in life. She responded well to HAART and her HIV/AIDS was well controlled. In addition to her HIV/AIDS disease, Paula is diagnosed with Hepatitis C (Hep C). While this condition was controlled, it has reached a point where Paula’s doctor is recommending she begin a new treatment. Paula also has significant circulatory problems, which cause her severe pain in her lower extremities. She uses prescribed narcotic pain medication to control her symptoms. Paula’s circulatory problems have also led to chronic ulcers on her feet that will not heal. Treatment for her foot ulcers demands frequent visits to a wound care clinic. Paula’s pain paired with the foot ulcers make it difficult for her to ambulate and leave her home. Paula has a tendency not to comply with her medical treatment. She often disregards instructions from her doctors and resorts to holistic treatments like treating her ulcers with chamomile tea. When she stops her treatment, she deteriorates quickly.
Maria was born HIV negative and received the appropriate HAART treatment after birth. She spent a week in the neonatal intensive care unit as she had to detox from the effects of the pain medication Paula took throughout her pregnancy.
Legal History: Previously, Paula used the AIDS Law Project, a not-for-profit organization that helps individuals with HIV address legal issues, such as those related to the child’s father . At that time, Paula filed a police report in response to Jesus’ escalating threats and successfully got a restraining order. Once the order was served, the phone calls and visits stopped, and Paula regained a temporary sense of control over her life.
Paula completed the appropriate permanency planning paperwork with the assistance of the organization The Family Center. She named Miguel as her daughter’s guardian should something happen to her. SOCW 6060: Social Work Theory and Practice – Paula Cortez Case Study
Alcohol and Drug Use History: Paula became an intravenous drug user (IVDU), using cocaine and heroin, at age 17. David was one of Paula’s “drug buddies” and suppliers. Paula continued to use drugs in the United States for several years; however, she stopped when she got pregnant with Miguel. David continued to use drugs, which led to the failure of their marriage.
Strengths: Paula has shown her resilience over the years. She has artistic skills and has found a way to utilize them. Paula has the foresight to seek social services to help her and her children survive. Paula has no legal involvement. She has the ability to bounce back from her many physical and health challenges to continue to care for her child and maintain her household.
David Cortez: father, 46 years old
Paula Cortez: mother, 43 years old
Miguel Cortez: son, 20 years old
Jesus (unknown): Maria’s father, 44 years old
Maria Cortez: daughter, 5 years old
Reference to the articles I submitted Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central Products – Ebook Central®
 
 Cowger, C.D. (1994) Assessing clients strengths: Clinical assessment for client empowerment. Social Work,39(3) 262-268.
Assessing client strengths: clinical assessment for client empowerment.
Authors:
Cowger CD
Affiliation:
School Social Work, Univ Illinois Urbana, 1207 W Oregon, Urbana IL 61801
Source:
Social Work (SOC WORK), May94; 39(3): 262-268. (7p)
Publication Type:
Journal Article
Language:
English
Major Subjects:
Empowerment
Social Work
Evaluation — Methods
Minor Subjects:
Social Identity; Professional-Patient Relations
Abstract:
The proposition that client strengths are central to the helping relationship is simple enough and seems uncontroversial as an important component of practice. Yet deficit, disease, and dysfunction metaphors are deeply rooted in clinical social work, and the emphasis of assessment has continued to be diagnosing abnormal and pathological conditions. This article argues that assessment in clinical practice, among other things, is a political activity. Assessment that focuses on deficits provides obstacles to client exercise of personal and social power and reinforces those social structures that generate and regulate unequal power relationships that victimize clients. Clinical practice based on metaphors of client strengths is also political in that it is congruent with the potential for client empowerment. This article discusses the importance of a client strengths perspective for assessment and proposes 12 practice guidelines that foster a strengths perspective.
Journal Subset:
Allied Health; Peer Reviewed; USA
ISSN:
0037-8046
MEDLINE Info:
PMID: NLM8209288 NLM UID: 2984852R
Entry Date:
20050425
Revision Date:
20150820
Accession Number:
107452079

Choose Language

Assessing Client Strengths: Clinical Assessment for Client Empowerment
Contents
Theory of Strengths Assessment
Assessment as Political Activity
Client Strengths and Empowerment
Importance of Assessing Strengths
Guidelines for Strengths Assessment
Conclusion
References
Full Text
The proposition that client strengths are central to the helping relationship is simple enough and seems uncontroversial as an important component of practice. Yet deficit, disease, and dysfunction metaphors are deeply rooted in clinical social work, and the emphasis of assessment has continued to be diagnosing abnormal and pathological conditions. This article argues that assessment in clinical practice, among other things, is a political activity. Assessment that focuses on deficits provides obstacles to client exercise of personal and social power and reinforces those social structures that generate and regulate unequal power relationships that victimize clients. Clinical practice based on metaphors of client strengths is also political in that it is congruent with the potential for client empowerment. This article discusses the importance of a client strengths perspective for assessment and proposes 12 practice guidelines that foster a strengths perspective.

Key Words: clients; clinical assessment; empowerment; practice effectiveness; strengths perspective

A focus on client strengths has received recent attention in the social work practice literature (Goldstein, 1990; Hepworth & Larsen, 1990; Saleebey, 1992; Weick, Rapp, Sullivan, & Kisthardt, 1989). The proposition that client strengths are central to the helping relationship is simple enough and seems uncontroversial as an important component of practice. Yet much of the social work literature suggests otherwise.

Review of the social work literature on human behavior and the social environment reveals that it provides little theoretical or empirical content on strengths. Much of the social work literature on practice with families continues to use treatment, dysfunction, and therapy metaphors and ignores work on family strengths developed in other disciplines. The assessment literature, including available assessment instruments, is overwhelmingly concerned with individual inadequacies. Taking a behavioral baseline of client deficits and examining the ability of social workers to correct those deficits have become the standard for evaluating the effectiveness of social work practice (Kagle & Cowger, 1984). Deficit, disease, and dysfunction metaphors are deeply rooted in social work, and the focus of assessment has “continued to be, one way or another, diagnosing pathological conditions” (Rodwell, 1987, p. 235).

This article discusses the importance of a client strengths perspective for assessment and proposes 12 practice guidelines to foster a strengths perspective. Though not addressed specifically to a strengths perspective, work on assessment by Logan and Chambers (1987), Rodwell (1987), and Meyer (1976) is particularly congruent with a strengths perspective and has been important to the author’s thinking.

Given that social work is expanding its influence into nearly every social institution, it is not surprising that its knowledge is diverse, lacks unity, and has significant gaps. In the excitement of this rapid growth some people lament epistemological problems and incongruities, whereas others proclaim they have found the answer or, at least, an answer that will help give unity and boundaries to the profession’s purpose and knowledge base. Although such a proclamation has its appeal, the profession is simply too diverse, and existing paradigms that emphasize client deficiencies are too entrenched for a strengths perspective to become a unifying metaphor. However, a strengths perspective does provide an alternative for practitioners who find the constructs of the approach consistent with their own views of practice.

Saleebey (1992) has argued that the relevance of a strengths perspective is generic and represents “good, basic social work practice” (p. 43). It is particularly important for mandated or involuntary clients because of the powerlessness implicit in the involuntary nature of the client-worker relationship. Rapp (1992), Kisthardt (1992), and Poertner and Ronnau (1992) have described the use of a strengths perspective with involuntary clients.

Theory of Strengths Assessment

This article is based on a mainstream contextual understanding that the primary purpose of social work is to assist people in their relationships with one another and with social institutions in such a way as to promote social and economic justice (Council on Social Work Education, 1984). Clinical practice focuses on the transactions between people and their environments. However, taking seriously the element of promoting social and economic justice in those transactions may not lead to a mainstream conception of practice. Indeed, clinical practice that considers social and economic justice suggests a type of practice that explicitly deals with power and power relationships.

This perspective understands client empowerment as central to clinical practice and client strengths as providing the fuel and energy for that empowerment. Client empowerment is characterized by two interdependent and interactive dynamics: personal empowerment and social empowerment. Although social work theories that split the attributes of people into the social and the psychological have considerable limitations (Falck, 1988), such a differentiation is made in this article to stress the importance of each element.

The personal empowerment dynamic is similar to a traditional clinical notion of self-determination whereby clients give direction to the helping process, take charge and control of their personal lives, get their “heads straight,” learn new ways to think about their situations, and adopt new behaviors that give them more satisfying and rewarding outcomes. Personal empowerment recognizes the uniqueness of each client.

The social empowerment dynamic recognizes that client definitions and characteristics cannot be separated from their context and that personal empowerment is related to opportunity. Social empowerment acknowledges that individual behavior is socially derived and identity is “bound up with that of others through social involvement” (Falck, 1988, p. 30). The person with social empowerment is a person who has the resources and opportunity to play an important role in his or her environment and in the shaping of that environment.

A person achieves personal and social empowerment simultaneously. For the client to achieve empowerment assumes that the resources and opportunity for that empowerment are available. Social justice, involving the distribution of society’s resources, is directly related to client social empowerment and, therefore, simultaneously to personal empowerment.

Clinical practice based on empowerment assumes that client power is achieved when clients make choices that give them more control over their presenting problem situations and, in turn, their own lives. However, empowerment-based practice also assumes social justice, recognizing that empowerment and self-determination are dependent not only on people making choices, but also on people having available choices to make. The distribution of available choices in a society is political. Societies organize systems of production and the distribution of resources, and that affects those choices differentially. Across societies, production and distribution are based on varying degrees of commitment to equity and justice: “Some people get more of everything than others” (Goroff, 1983, p. 133). Social work practice based on the notion of choice requires attention directed to the dynamics of personal power, the social power endemic to the client’s environment, and the relationship between the two.

Assessment as Political Activity

Assessment that focuses on deficits provides obstacles to clients exercising personal and social power and reinforces those social structures that generate and regulate the unequal power relationships that victimize clients. Goroff (1983) persuasively argued that social work practice is a political activity and that the attribution of individual deficiencies as the cause of human problems is a politically conservative process that “supports the status quo” (p. 134).

Deficit-based assessment targets the individual as “the problem.” For example, from a deficit perspective the person who is unemployed becomes the problem. Social work interventions that focus on what is wrong with the person–for example, why he or she is not working–reinforce the powerlessness the client is already experiencing because he or she does not have a job. At the same time such an intervention lets economic and social structures that do not provide opportunity “off the hook” and reinforces social structures that generate unequal power. To assume that the cause of personal pain and social problems is individual deficiency”has the political consequences of not focusing on the social structure (the body politic) but on the individual. Most, if not all, of the pain we experience is the result of the way we have organized ourselves and how we create and allocate life-surviving resources” (Goroff, 1983, p. 134).

Personal pain is political. Clinical social work practice is political. Diagnostic and assessment metaphors and taxonomies that stress individual deficiencies and sickness reinforce the political status quo in a manner that is incongruent with clinical practice that attempts to promote social and economic justice. Practice based on pathology is subject to the “blaming the victim” characterization of Ryan (1976). Clinical practice based on metaphors of client strengths and empowerment is also political in that its thrust is the development of client power and the equitable distribution of societal resources.

Client Strengths and Empowerment

Promoting empowerment means believing that people are capable of making their own choices and decisions. It means not only that human beings possess the strengths and potential to resolve their own difficult life situations, but also that they increase their strength and contribute to society by doing so. The role of the social worker in clinical practice is to nourish, encourage, assist, enable, support, stimulate, and unleash the strengths within people; to illuminate the strengths available to people in their own environments; and to promote equity and justice at all levels of society. To do that, the social worker helps clients articulate the nature of their situations, identify what they want, explore alternatives for achieving those wants, and achieve them.

The role of the social worker is not to change people, treat people, help people cope, or counsel people. The role is not to empower people. As Simon (1990) argued, social workers cannot empower others: “More than a simple linguistic nuance, the notion that social workers do not empower others, but instead, help people empower themselves is an ontological distinction that frames the reality experienced by both workers and clients” (p. 32). To assume a social worker can empower someone else is naive and condescending and has little basis in reality. Power is not something that social workers possess for distribution at will. Clients, not social workers, own the power that brings significant change in clinical practice. A clinical social worker is merely a resource person with professional training on the use of resources who is committed to people empowerment and willing to share his or her knowledge in a manner that helps people realize their own power, take control of their own lives, and solve their own problems.

Importance of Assessing Strengths
Central to a strength’s perspective is the role and place of assessment in the practice process. How clients define difficult situations and how they evaluate and give meaning to the dynamic factors related to those situations set the context and content for the duration of the helping relationship (Cowger, 1992). If assessment focuses on deficits, it is likely that deficits will remain the focus of both the worker and the client during remaining contacts. Concentrating on deficits or strengths can lead to self-fulfilling prophecies. Hepworth and Larsen (1990) articulated how this concentration might also impair a social worker’s “ability to discern clients’ potentials for growth,” reinforce “client self-doubts and feelings of inadequacy,” and predispose workers to “believe that clients should continue to receive service longer than is necessary” (p. 195).

Emphasizing deficits has serious implications and limitations, but focusing on strengths provides considerable advantages. Strengths are all we have to work with. Recognition of strengths is fundamental to the value stance and mission of the profession. A strengths perspective provides for a leveling of the power relationship between social workers and clients. Clients enter the clinical setting in a vulnerable position and with comparatively little power. Their lack of power is inherent in the reason for which they are seeking help and in the social structure of service. A deficit focus reinforces this vulnerability and highlights the unequal power relationship between the worker and the client.

A strengths perspective reinforces client competence and thereby mitigates the significance of unequal power between the client and social worker and, in so doing, presents increased potential for liberating people from stigmatizing diagnostic classifications that reinforce “sickness” in individuals, families, and communities (Cowger, 1992). A strengths perspective of assessment provides structure and content for an examination of realizable alternatives, for the mobilization of competencies that can make things different, and for the building of self-confidence that stimulates hope.

Guidelines for Strengths Assessment

Assessment is a process as well as a product. Assessment as process is helping clients define their situations (that is, clarify the reasons they have sought assistance) and assisting clients in evaluating and giving meaning to those factors that affect their situations. It is particularly important to assist clients in telling their stories. The client owns that story, and if the social worker respects that ownership, the client will be able to more fully share it. The word “situation” has a particularly important meaning because it affirms the reality that problems always exist in an environmental context.

The following guidelines are based on the notion that the knowledge guiding the assessment process is based on a socially constructed reality in the tradition of Berger and Luckmann (1966). Also, the assessment should recognize that there are multiple constructions of reality for each client situation (Rodwell, 1987) and that problem situations are interactive, multicausal, and ever-changing.

Give preeminence to the client’s understanding of the facts. The client’s view of the situation, the meaning the client ascribes to the situation, and the client’s feelings or emotions related to that situation are the central focus for assessment. Assessment content on the intrapersonal, developmental, cognitive, mental, and biophysical dynamics of the client are important only as they enlighten the situation presented by the client. They should be used only as a way to identify strengths that can be brought to bear on the presenting situation or to recognize obstacles to achieving client objectives. The use of social sciences behavior taxonomies representing the realities of the social scientists should not be used as something to apply to, thrust on, or label a client. An intrapersonal and interpersonal assessment, like data gathered on the client’s past, should not have a life of its own and is not important in its own right.

Believe the client. Central to a strengths perspective is a deeply held belief that clients ultimately are trustworthy. There is no evidence that people needing social work services tell untruths any more than anyone else. To prejudge a client as being untrustworthy is contrary to the social work-mandated values of having respect for individuals and recognizing client dignity, and prejudgment may lead to a self-fulfilling prophecy. Clients may need help to articulate their problem situations, and “caring confrontation” by the worker may facilitate that process. However, clients’ understandings of reality are no less real than the social constructions of reality of the professionals assisting them.

Discover what the client wants. There are two aspects of client wants that provide the structure for the worker-client contract. The first is, What does the client want and expect from service? The second is, What does the client want to happen in relation to his or her current problem situation? This latter want involves the client’s goals and is concerned with what the client perceives to be a successful resolution to the problem situation. Although recognizing that what the client wants and what agencies and workers are able and willing to offer is subject to negotiation, successful practitioners base assessments on client motivation. Client motivation is supported by expectations of meeting one’s own goals and wants.

Move the assessment toward personal and environmental strengths. Obviously there are personal and environmental obstacles to the resolution of difficult situations. However, if one believes that solutions to difficult situations lie in strengths, dwelling on obstacles ultimately has little payoff.

Make assessment of strengths multidimensional. Multidimensional assessment is widely supported in social work. Practicing from a strengths perspective means believing that the strengths and resources to resolve a difficult situation lie within the client’s interpersonal skills, motivation, emotional strengths, and ability to think clearly. The client’s external strengths come from family networks, significant others, voluntary organizations, community groups, and public institutions that support and provide opportunities for clients to act on their own behalf and institutional services that have the potential to provide resources. Discovering these strengths is central to assessment. A multidimensional assessment also includes an examination of power and power relationships in transactions between the client and the environment. Explicit, critical examination of such relationships provides the client and the worker with the context for evaluating alternative solutions.

Use the assessment to discover uniqueness. The importance of uniqueness and individualization is well articulated by Meyer (1976): “When a family, group or a community is . . . individualized, it is known through its uniqueness, despite all that it holds in common with other like groups” (p. 176). Although every person is in certain respects “like all other men [sic], like some other men, and like no other men” (Kluckholm, Murray, & Schneider, 1953, p. 53), foundation content in human behavior and social environment taught in schools of social work focuses on the first two of these, which are based on normative behavior assumptions. Assessment that focuses on client strengths must be individualized to understand the unique situation the client is experiencing. Normative perspectives of behavior are only useful insofar as they can enrich the understanding of this uniqueness. Pray’s (1991) writings on assessment emphasize individual uniqueness as an important element of Schon’s (1983) reflective model of practice and are particularly insightful in establishing the importance of client uniqueness in assessment.

Use language the client can understand. Professional and social sciences nomenclature is incongruent with an assessment approach based on mutual participation of the social worker and the client. Assessment as a product should be written in simple English and in such a way as to be self-explanatory. Goldstein (1990) convincingly stated, “We are the inheritors of a professional language composed of value-laden metaphors and idioms. The language has far more to do with philosophic assumptions about the human state, ideologies of professionalism, and, not least, the politics of practice than they do with objective rationality” (p. 268).

Make assessment a joint activity between worker and client. Social workers can minimize the power imbalance inherent between worker and client by stressing the importance of the client’s understandings and wants. The worker’s role is to inquire and listen and to assist the client in discovering, clarifying, and articulating. The client gives direction to the content of the assessment. The client must feel ownership of the process and the product and can do so only if assessment is open and shared. Rodwell (1987) articulated this well when she stated that the “major stakeholders must agree with the content” (p. 241).

Reach a mutual agreement on the assessment. Workers should not have secret assessments. All assessments in written form should be shared with clients. Because assessment is to provide structure and direction for confronting client problem situations, any privately held assessment a worker might have makes the client vulnerable to manipulation.

Avoid blame and blaming. Assessment and blame often get confused and convoluted. Blame is the first cousin of deficit models of practice. Concentrating on blame or allowing it to get a firm foothold on the process is done at the expense of getting on with a resolution to the problem. Client situations encountered by social workers are typically the result of the interaction of a myriad of events: personal interactions, intrapersonal attributes, physical health, social situations, social organizations, and chance happenings. Things happen; people are vulnerable to those happenings, and, therefore, they seek assistance. What can the worker and client do after blame is ascribed? Generally, blaming leads nowhere, and, if delegated to the client, it may encourage low self-esteem. If assigned to others, it may encourage learned helplessness or deter motivation to address the problem situation.

Avoid cause-and-effect thinking Professional judgments or assumptions of causation may well be the most detrimental exercises perpetrated on clients. Worker notions of cause and causal thinking should be minimized because they have the propensity to be based on simplistic cause-and-effect thinking. Causal thinking represents only one of many possible perspectives of the problem situation and can easily lead to blaming. Client problem situations are usually multidimensional, have energy, represent multidirectional actions, and reflect dynamics that are not well suited to simple causal explanations.

Assess; do not diagnose. Diagnosis is incongruent with a strengths perspective. Diagnosis is understood in the context of pathology, deviance, and deficits and is based on social constructions of reality that define human problem situations in a like manner. Diagnosis is associated with a medical model of labeling that assumes unpopular and unacceptable behavior as a symptom of an underlying pathological condition. It has been argued that labeling “accompanied by reinforcement of identified behavior is a sufficient condition for chronic mental illness” (Taber, Herbert, Mark, & Nealey, 1969, p. 354). The preference for the use of the word “assessment” over “diagnosis” is widely held in the social work literature.

Conclusion
Inherent in the guidelines is the recognition that to focus on client strengths and to practice with the intent of client empowerment is to practice with an explicit power consciousness. Whatever else social work practice is, it is always political, because it always encompasses power and power relationships. The guidelines are not intended to include all the assessment content and knowledge that a social worker must use in practice. Indeed, important topics such as assessing specific obstacles to empowerment, assessing power relationships, and assessing the relationship between personal empowerment and social empowerment of the individual client are not considered. The use of the guidelines depends on given practice situations, and professional judgment determines their specific applicability. They are proposed to provide an alternative approach to existing normative and deficit models of diagnosis and treatment. The guidelines may also be of interest to practitioners who wish to use them to supplement existing assessment paradigms they do not wish to give up.

Chapter 5
Assessment of Adults

Elaine Congress

Purpose: This chapter presents challenges and different evidence-informed
assessments used with adult clients in a variety of practice settings.
Rationale: Clients present with a range of different problems that require
different assessment protocols and approaches.
How evidence-informed practice is presented: A variety of assessment theories
and tools used with clients who present with a variety of psychosocial problems
is presented in this chapter.
Overarching question: What are five essential ingredients one must consider
to make an effective assessment of an adult client?

In order to provide effective evidence-based interventions with adult
clients, a thorough assessment is essential. Although fundamental in
planning and providing effective treatment for adult clients, assessment
is a challenging endeavor. Although there are a variety of definitions of
social work assessment, this chapter is based on the following definition
from the Social Work Desk Reference:

Assessment is the process of systematically collecting data about a client’s func-
tioning and monitoring progress in client functioning on an ongoing basis.
Assessment is defined as a process of problem selection and specification that is
guided in social work by a person in environment systems orientation. Assess-
ment is used to identify and measure specific problem behaviors as well as
protective and resilience factors, and to determine if treatment is necessary.
Information is usually gathered from a variety of sources (e.g., individual, fam-
ily member, case records, observation, rapid assessment tools and genograms).
Types of assessment include bio-psycho-social history taking, multiple dimen-
sional crisis assessment, symptom checklists, functional analysis, and mental
status exams.

—(Roberts & Greene, 2002, p. 830)

Using the social work framework of person in environment, a suc-
cessful assessment involves understanding the individual not only as a
physical and psychological entity but also as one engaged in a relationship
with both micro- and macro-environments. In looking at the intersection
of this person in an environmental matrix, the social worker is in the best
position to complete a comprehensive client assessment. Although many
regard social work assessment as focusing on problems and diagnosis,
the assessment of strengths and resilience is as important in completing a
comprehensive assessment of the client. Other common features of current

125
Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central http://ebookcentral.proquest.com
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126 Social Work Practice With Individuals and Families

social work assessment models outlined by Jordan and Franklin (2003)
include the following:

• Social work assessment models are eclectic and integrative and are
not based on one underlying theory.

• Long history taking is deemphasized, and there is a focus on seeking
only relevant history that is related to the function of service. For
example, a social worker in a medical setting might be most interested
in past and present physical health, whereas a social worker in a
family-therapy agency might focus on past and present history of
family relationships.

• Social work assessment involves a collaborative process between
client and worker. Using an evidence-based practice (EBP) approach,
the client is actively involved in sharing information with the goal
of deciding on the best possible treatment. Involving the client in a
short-term active participatory approach to diagnosis is the best way
to ensure that the client continues to participate in treatment.

• Assessment and treatment are seen as a unified whole. There is
no longer a lengthy assessment period during which clients’ needs
and problems are held in abeyance. Having a short-term focused
assessment enables the client to see the relevance of assessment and
helps ensure that the client will remain in treatment. A corollary
of this is that assessment does not end before intervention begins.
Assessment continues throughout the treatment process. With an
ongoing assessment process, the social worker can modify treatment
based on new information that emerges from the ongoing assessment
process.

A comprehensive client assessment includes many factors, both in
terms of the individual (appearance, developmental history, past and
current physical health, cognitive ability and style, intellectual capacity,
mental status, psychiatric diagnosis, and cultural/racial identity) as well
as the individual relationship to environment (role within family, family
history, physical environment of home and neighborhood, and relationship
to the outside community). An important part of the assessment process
involves focusing not only on the deficits that a client presents but also on
the client’s strengths and resilience.

There are many challenges to completing a comprehensive assess-
ment of a client. First, with the current focus on short-term treatment
models, a thorough assessment is often not possible. Clinicians frequently
focus only on information needed to complete forms or to select an
intervention. In fact, many EBP models look primarily at the client’s partic-
ipation in the choice of intervention and minimize the assessment process.
Yet a thorough assessment is most helpful in making the best intervention
decision.

Another challenge has been that assessment is often accomplished
with a singular focus. Some assessment models favor an individual

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central http://ebookcentral.proquest.com
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Assessment of Adults 127

psychological assessment, whereas others look more at environmental
factors influencing the client. The best assessment involves an integra-
tive approach that uses a broad lens for assessing clients from both
bio-psychosocial and person-in-environment perspectives. Often, a rating
scale, such as the one developed by Pomeroy, Holleran, and Franklin
(2003), is helpful in providing a comprehensive individual assessment.

Another frequent criticism of assessment is that it often relies on a
deficit model. The assessment of a client often involves diagnosis using
DSM-IV. Applying only a DSM-IV diagnosis to a client focuses on a
psychiatric problem and pathology and neglects strengths that should be
viewed as important aspects of assessment and intervention with clients.

There is much current emphasis on accurate assessment following
a traumatic event. The usual belief that having the individual relive the
traumatic event has been challenged by recent evidence (Dyregrov & Regel,
2012) that suggests that rapid assessment followed by early intervention is
the most effective treatment.

Historical Background

Psychosocial Diagnostic Assessment

From the birth of the social work profession, many different assessment
models have been used. Perhaps the most well known is the psychoso-
cial or diagnosis approach first developed by Hollis. This model relies
heavily on family and developmental history to reach a psychodiagnostic
assessment of the client. An ego-psychology framework (Goldstein, 2002)
is fundamental to this approach. Although this approach initially focused
to a large extent on a client’s developmental history, now the person/client
in relationship to the current environment is stressed. According to a
psychosocial-ego-psychology perspective, the assessment process has the
following steps: (a) assessing the client’s interactions with his or her
environment in the here and now and how successfully he or she is
coping effectively with major life roles and tasks; (b) assessing the client’s
adaptive, autonomous, and conflict-free areas of ego functioning as well
as ego deficits and maladaptive functioning; (c) evaluating the impact of
a client’s past on current functioning; and (d) examining environmental
obstacles that impede a client’s functioning (Goldstein, 2002; Hollis &
Wood, 1981). According to a psychosocial diagnostic approach, informa-
tion for client assessment was collected in a variety of ways, including
(a) psychiatric interviews to determine a diagnosis, (b) the use of standard-
ized and projective testing to support diagnostic assessment, (c) current
psychosocial assessment and study of prior development and adjustment
to identify problem areas, (d) use of standardized interviewing to assess
problem areas and current functioning, and (e) study of the client-social
work relationship to ascertain client’s patterns of interactions (Jordan &
Franklin, 2003).

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central http://ebookcentral.proquest.com
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128 Social Work Practice With Individuals and Families

The psychosocial assessment model is well suited to today’s medi-
cal model that involves the study, diagnosis, and treatment format. Many
medically based behavioral-health settings use this approach. Furthermore,
the focus of many behavioral-health centers on clients’ return to more
adaptive functioning is also compatible with a psychosocial-diagnostic-ego-
psychology model. A DSM-IV diagnosis is usually a requirement for begin-
ning treatment, and thus the detailed study using a psychosocial approach
is often helpful in arriving at a diagnosis. Structured assessment tools, such
as the eco-map (Hartman & Laird, 1983) and the genogram (McGoldrick,
Gerson, & Schallenberg, 1999), are also helpful for practitioners in com-
pleting assessments. There is a need for more outcome-focused research,
however, on the effectiveness of using these instruments. Finally, the devel-
opment of standardized semistructured interviews using a psychosocial
approach is most helpful in promoting current evidence-based assessment.

Problem-Solving Assessment

Another major assessment model was the problem-solving assessment
originally developed by Helen Harris Perlman in 1957. This model is based
on the psychosocial diagnosis model described earlier and the functional
model that focuses on growth and potential as well as agency function.
Perlman saw assessment as an eclectic model with four Ps—person,
problem, place, and process—as a way to organize information about the
client. In terms of person, the social worker should think of the client’s
personality characteristics and which interactions with the environment
are significant. A second area involves a focus on problem: How can the
problem be defined? Is it a crisis, a repetitive issue? What other ways
has the client sought to resolve the problem? The third category is place
or agency. What concerns does the client have about contact within the
agency? What is most helpful and what is most harmful about the agency
in the process of client assessment? The fourth relates to process. Which
intervention will be most successful? What will be the consequences of a
particular choice of treatment?

Current assessment still relies a great deal on the problem-solving
approach to assessment. First, a very quick assessment tool, such as
that outlined by Perlman, is most helpful in the current social-service
environment, with its focus on short-term assessment and intervention.
Another advantage, especially for culturally diverse clients who may be
fearful of interaction with the agency, is the inclusion of Perlman’s third
P—place—in the assessment process. This approach encourages the social
worker to look at how the fears and feelings that clients may have about
the agency affect the assessment process. This may be especially true for
undocumented clients who are apprehensive that social workers will use
their power and authority to report their immigration status.

There are two major concerns about the problem-solving approach
as used in current assessment practice. First, there is limited attention to
the person’s strengths and resilience in resolving the problem. Modern

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central http://ebookcentral.proquest.com
Created from waldenu on 2020-12-28 16:45:10.

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Assessment of Adults 129

assessment models seek to focus specifically on the strengths a client
brings to the situation. The client’s definition of the ‘‘problem’’ and what
strengths he or she can use and has used in the past to address the
problem are considered key. Another major concern about the problem-
solving approach is that it is based primarily on practice wisdom, with
limited empirical research to support its use. With the emphasis on EBP,
research is needed to ascertain the effectiveness of this assessment model
as a foundation for treatment interventions with diverse clients.

Cognitive-Behavior Assessment

Cognitive-behavior assessment models have made a major contribution to
current practice and research about assessment. Meichenbaum (1993) out-
lines three metaphors that have guided this complex model—conditioning,
information processing, and constructive narrative. Early cognitive behav-
iorists focused primarily on conditioning as the way certain behaviors were
learned. Then the focus shifted to a greater emphasis on cognitions, social
learning, and the development of belief systems. Most recently, the focus
has been on the use of client narratives and life stories as part of the
assessment process.

Jordan and Franklin (2003) identify four attributes of cognitive behav-
ior assessment that are particularly useful in today’s practice:

1. Because much of today’s practice focuses on short-term intervention,
the focus on rapid assessment and treatment is particularly useful.
Assessment includes history only as it is related to the client’s current
functioning, but the main focus is on identifying the faulty learning
and cognitive patterns that have contributed to current maladaptive
behavior.

2. Much research has been conducted on outcomes of cognitive behavior
approaches. This is particularly useful with today’s emphasis on
evidence-based assessment and treatment.

3. Many assessment and treatment manuals for use with assessing a
number of identified client problems, such as depression, substance
abuse, personality disorders, and posttraumatic stress disorder, have
been developed using the cognitive-behavioral approach.

4. Ongoing assessment has been stressed as essential in evaluating
the effectiveness of treatment. The integration of assessment with
treatment is very much part of current beliefs about assessment.

Life-Model Assessment

The life-model assessment (Germain & Gitterman, 1996) uses an ecological
framework that focuses on the client’s interactions with the environment
in three main areas—life transitions, environmental pressures, and mal-
adaptive interpersonal processes. Major aims of this theory are to closely
link person and environment, stress the client’s perspective, and provide
linkages among direct service, administration, and policy planning.

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central http://ebookcentral.proquest.com
Created from waldenu on 2020-12-28 16:45:10.

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130 Social Work Practice With Individuals and Families

There has been some concern that the life-model assessment does
not guide current practice interventions very well (Wakefield, 1996). With
the need for short-term evidence-based assessment and intervention, the
weakness of this link is problematic. The ecological model, however,
has served as a foundation for developing multisystematic therapy, an
evidence-based therapy that has proven to be useful with youth and fam-
ilies (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998).
An assessment tool, such as the eco-map (Hartman & Laird, 1983) that
is based on the life-model ecological approach, has been useful, although
research on this has been limited. Computer software programs may help
practitioners use this assessment tool more effectively, standardize its use,
and provide more opportunities for research about its effectiveness.

Task-Centered Assessment

The task-centered assessment model developed by Reid (1988) focuses
on specific target problems and their desired outcomes. Major steps in
this model include task planning, implementation, and review. Task plan-
ning builds on initial problem formulation. The client’s perception of the
problem is considered most important, and the practitioner helps the client
in exploring, clarifying, and specifying the problem. Task-centered assess-
ment focuses on a thorough understanding of the client’s problems and
goals, prioritizing problems and developing a specific contract to achieve
the defined goals. This approach is most useful in practice today with a
focus on time-limited and evidence-based outcomes.

Solution-Focused Assessment

A major new assessment model is the brief solution-focused therapy
assessment developed by De Jong and Berg (2001) for work with mandated
clients. With this model, assessment is part of the intervention process.
Franklin and Moore (1999) have identified the following methods for
conducting a solution-focused assessment:

• Tracking solution behaviors or exceptions to the problem.

• Scaling the problem.

• Using coping and motivation questions.

• Asking the miracle question.

This approach is very client centered and focuses on client’s
strengths—what clients can do and want to do, not on their deficits and
failures. Franklin (2002) identifies positive features of this model with
mandated clients:

• Using a nonjudgmental approach in understanding client problems.

• Making the congruence between what the client wants and what
services can be provided as close as possible.

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central http://ebookcentral.proquest.com
Created from waldenu on 2020-12-28 16:45:10.

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Assessment of Adults 131

• Emphasizing clients’ choices as much as possible.

• Providing education to clients about what treatment will involve.

• Developing specific goals with clients.

• Discussing what is nonnegotiable from the agency’s standpoint.

Although research on the use of this model has been positive, more
work in this area is necessary to evaluate its effectiveness.

Strengths-Perspective Assessment

A final perspective that has had a major influence on current assessment
practice is the strengths perspective developed by Saleeby (1997). This per-
spective is fundamental to the values-based perspective of social work in
that all people are seen as having dignity and worth as individuals as well as
the right to self-determination. Using this approach, the practitioner looks
for knowledge, competencies, hidden resources, and resilience in each and
every client who comes for treatment. The practitioner moves away from
identifying only deficits or diagnosing pathology with DSM-IV toward a
broader understanding of person-in-environment client functioning. The
strengths perspective has had a significant impact on mental-health ser-
vices. Yet the strengths perspective is often seen as only one aspect of
a comprehensive assessment, with a diagnostic DSM-IV approach having
more importance in a behavioral-health service-delivery system. There
have been various attempts to develop standardized measures to assess
strengths and competencies (Jordan & Franklin, 2003) and also to incorpo-
rate a strengths approach into a more traditional psychosocial assessment.
Incorporating a strengths-based assessment process has been used in work
with battered women (Lee, 2007). With the current emphasis on evidence-
based assessment and practice, much more empirical research is needed
on outcomes with strengths-based assessment.

Summary of Current Evidence-Based Assessment
for Individuals

There are a number of sources of information that a social worker can use
in completing assessments on individual clients. These sources include:

• Background information on clients from case records.

• Verbal reports from clients about their feelings, history, and problems.

• Direct observation of nonverbal behavior.

• Observation of interaction with family members and others in clients’
environment.

• Collateral information from families, relatives, physicians, teachers,
employers, and other professionals.

• Tests or other assessment instruments.

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central http://ebookcentral.proquest.com
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132 Social Work Practice With Individuals and Families

Social workers often begin to work with clients after reading lengthy
case records. Although there are advantages to having a preliminary
understanding of a client before contact is made, the major disadvantage
is that case records may unduly influence the social worker’s perception
of the client. Case records are often written from a deficit perspective.
Frequently, a DSM-IV diagnosis is included that may not be current.
This may be especially true in mental-health settings when the client has
had a long history of mental-health treatment. Research on whether the
assessment process is helped or hindered by the social worker’s prior
perusal of a case record is needed.

The primary source of information for assessment should come
directly from the client. The practitioner needs to be a skilled interviewer
to elicit information that is particularly relevant to the client’s problem.
Previously, client assessment was a very lengthy process, often spanning
several interviews. The current trend is brief assessment to learn informa-
tion that is particularly pertinent to the client problem and what will be
most helpful in future work. A thorough assessment usually includes the
following categories (Cooper & Lesser, 2002):

• Identifying information.

• Referral source.

• Presenting problem.

• History of the problem.

• Previous counseling experiences.

• Family background.

• Developmental history.

• Educational history.

• Employment history.

• History of trauma.

• Medical history.

• Cultural history.

• Spirituality/religion.

• Mental status and current functioning.

• Mental status exam.

• Multiaxial DSM-IV diagnosis.

• Recommendations and goals for treatment.

• Plans to evaluate.

Including an evaluation plan provides an empirical foundation for
the assessment process.

A major source of information for assessment comes from the
social worker’s observation of nonverbal behavior. What demographic

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central http://ebookcentral.proquest.com
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Assessment of Adults 133

information do we learn nonverbally—sex, age, race? How is the client
dressed? How does the client answer questions? How does the client relate
to the worker?

Often, the social worker has an opportunity to observe the indi-
vidual client in interaction with others—family members, friends, group
members, or other professionals. This can be an important source of
information about the client’s challenges in personal relationships with
others.

The social worker can learn important information about the client
from collateral contact with others, including family and other profession-
als. It is important, however, that the social worker not rely too much
on negative reports of family members. Family members may present
distorted views of clients based on their own interests. Reports from others
should only be a secondary method for receiving information to use in a
client assessment.

The final method of gathering information for assessment is through
tests or assessment instruments. Because many of these instruments have
been standardized, assessment through these measures is considered
important in promoting EBP.

Assessment Scales and Tools

The next section explores some of the scales and assessment tools that
have been used in assessment of individual clients.

One of the earliest and most well-known scales is the Wechsler
Adult Intelligence Scale (WAIS), first published in 1955 and now in its
fourth edition (2007). The current version, which is used to measure adult
intelligence of people between 16 and 90 years of age, consists of 10 core
subtests and 5 supplemental subtests. The 10 core subtests include under
the area of verbal comprehension, similarities, vocabulary, information;
under the area of perceptual reasoning, block design, matrix reasoning,
and visual puzzles; under the area of working memory, digit span and
arithmetic; and under the area of processing speed, symbol search and
coding. The median full-scale IQ is 100, and 68% of adults fall within one
standard deviation, or within 85 to 115. It has been suggested that there
may be age differences that are not sufficiently taken into account in WAIS
IV (Benson, Hulac, & Kranzler, 2010).

The person-in-environment (PIE) testing scale developed by Pomeroy
et al. (2003) is helpful in that each area is considered either as a problem
or strength. The categories are appearance, biomedical/organic, use of
substances, developmental issues/transitions, coping abilities, stressors,
capacity for relationships, social functioning, behavioral function, sexual
functioning, problem-solving/coping skills, creativity, cognitive function-
ing, emotional functioning, self-concept, motivation, cultural and ethnic
identification, role functioning, spirituality/religion, and …