Comprehensive Assessment and the use of Structured Assessment Schedules
Finance & housing
Effect of medication Physical Health Coping Skills
Mental State
Areas to be assessed
Social Needs
Risk Works Skills Strengths Social Functioning
Functions of Assessment
Assessments Used primarily for assessing clients needs for planning treatment
Some measures, but not all, can serve both functions
Outcome Measures Used primarily to demonstrate changes over time, I.e. the outcomes of treatment
Ref: Clarke et al (2001) Outcome Measures. COT
Wed: by her GP
Wed in A&E by the Tues: seen by CPN • Triage nurse
Jane’s experience of assessment
•SHO
Fri: by the OT Thurs: by her Consultant
Weds: on the ward by the • Nurse • SHO
Principles of Good Assessment
• Choosing an appropriate assessment strategy • Promoting engagement and assessment • Using Data collection skills effectively • Making use of the data • Ongoing process
Engagement and Partnership
Pre- Planning Choose timing carefully Allow plenty of time privacy Orientation Introduce yourself and explain your role Ask patient the name they prefer to be used Explain the assessment process Check out patient’s expectations Explain purpose of the assessment Confidentiality
Engagement and Partnership (cont…)
Negotiate and agree an agenda Agree duration of the assessment Work with the patients priorities Communication skills Show respect Explain terms and avoid jargon if possible Clarify and check understanding Watch out and listen out for clues in what’s being said or how it’s said
Engagement and Partnership (cont…)
Conveying Outcomes Give clear, honest and focussed feedback of the findings Explain the implications of your findings Start on issues where progress can be made quickly Focus on the strength
Factors which Influence Choice of Assessment Strategy
• What information is already available? • What are the aims of the assessment? • What is the best strategy to gather the information and meet these aims? use a variety of methods use a variety of tools give preference to valid and reliable tools • Own Capability
Layers of Information Gathering
Global Assessments HoNOS
Clarifying assessments
Symptoms Positive Negative Affective 1. 2. 3.
Needs Housing Finances Employment Collate findings and give feedback Conduct a semi-structured interview Agree a problem statement and goals
Functioning Life Skills Relationships Social Support
Symptom Assessment
Comprehensive mental state assessment KGV BPRS
Positive symptoms Hallucinations – BAVQ Delusions - DRS
Negative Symptoms SFS SANS
Affective Symptoms Depression – BDI Anxiety – FQ Suicidality - BHS
Clarifying Assessments
Substance Misuse MAST Medication LUNSERS Depression – BDI Anxiety – FQ Suicidality – BHS Medication - LUNSERS
Needs Assessment
Comprehensive Assessment CAN Clarifying Assessment
Housing
Finances
Employment
Findings and Interventions
Advantages of Structured Assessment • • • • • • • Reliable and Valid Measurable Inclusive Consistent Specific Focussed Linked to Interventions
Disadvantages of Structured Assessments • • • • • • • Fixed Agenda Lacks freedom to explore clients agenda Formal Sometimes off-putting to clients Information may be isolated from its context Can be time consuming Can be impractical
Advantages to unstructured Assessments
• • • •
User centred focus and process May be less threatening May help engagement Flexible
Disadvantages to unstructured Assessments • • • • • • • May miss important information Not Measurable Difficult to record Lacks boundaries Inconsistent More Subjective Not evidence based
Validity Concurrent • How well the test correlates with other well validated measures of the same topic administered at the same time Content • How well-balanced the items are as a sample of the content domain to be measured Construct • How well the test links up with a set of theoretical assumptions about an abstract construct.
Reliability The degree of consistency in measurement:• Over time – when carried out at different times by the same researcher. • Between raters – when used at the same time by different raters.
Neither Valid or Reliable
Reliable but not Valid
Valid and reliable