Chapter 7: Assessment, Formulation, ​ and Goal Setting

on midterm

Clinical work involves:

1. Assessment: Understanding the client's situation.

2. Formulation and conceptualization: Identifying assets, needs, and issues.

3. Development of specific goals: Collaborative process between clinician and client.

4. Intervention/treatment plan: Developed after the above steps.

Collaborative Assessment (or Consumer-Focused Assessment):

• Both clinician and client conduct the assessment together.

• Challenges the "evaluator versus subject" mindset.

• Focuses on gathering and analyzing information collaboratively, including the client's story and larger system/contextual influences.

Two Levels of Assessment

• Process of the Assessment​

• Content of the Assessment​

Process of the Assessment

Questions guide the assessment process itself:

• Why: Why has the client come or been referred? Why are we doing this assessment?

• Who: Who is the client (individual, group, family, etc.)? Who should be involved in the process? Who made the referral or supported the request?

• What: What does the client want to know? What do we need to know? What sociocultural, spiritual, logistical, linguistic, and health factors should influence the assessment?

• How: How will we gather the information? What methods are most useful? How will we evaluate the usefulness of our plans?

• Where: Where should the assessment take place (e.g., office, home, shelter)?

• When: When will we have enough understanding to begin planning and contracting?

Content of the Assessment​

Questions focus on understanding the client’s situation and identifying goals:

• Who: Who are the main participants in the successes and problems of the system being assessed?

• What: What are the problems, strengths, resources, and needs? What are the barriers and incentives for change? What will change look like?

• Where: Where do the successes/problems occur, and where are interventions likely to be effective?

• Why: Why is the client presenting at this time, and why would they continue after the first meeting?

• When: When did major events occur? When did the problems start or escalate? When did the client contact professionals? When do I enter the client's story?

• How: How can we collaborate to provide effective help? How can we adapt to make the relationship and work feel safe and helpful?

Formal Clinical Assessment

• Typically conducted for diagnosis, treatment planning, or research.

• Used to determine eligibility for specialized services (e.g., disability payments, residential placement, inpatient treatment).

There are many different types of assessment and they are ONGOING…​

• Strengths​

• Social Supports​

• Family Functioning ​

• Coping Strategies / Ego Defences ​

• Social Role / Social Performance​

• Self-Concept ​

• Level of Care​

• Developmental delays ​

• Human Service Needs ​

• Assessing for the need of child protection ​

• Mental / Physical health ​

• Risk​

Technology-assisted assessment

The use of computers or other technological devices to gather assessment data, interpret the data, or write assessment reports. ​

• Example – The Service Planning Instrument (SPIn) an adult risk/needs assessment tool for criminal justice staff to use with their clients.​

AHS Connect Care has so many built-in assessments.  ​

Methods of Assessment​

• Interviews

• Observation

• Tests

• Review of Life Records

Review of Life Records

• Clinicians may review records such as past treatments, school records, and previous test reports.

• Caution: Reports may not accurately reflect the client's present state.

• Social Media: Clinicians can find public information about clients (e.g., Facebook, LinkedIn), but this poses ethical challenges. It can impact trust in the therapeutic relationship.

• Ethical Considerations: Clinicians should avoid gathering information from the internet without explicit client consent. Information should be obtained transparently, with informed consent and adherence to confidentiality rules (e.g., HIPAA).

Tests

Types:

• Standardized Tests: Intelligence tests (e.g., Wechsler Intelligence Scale), personality tests (e.g., MMPI-2), symptom checklists (e.g., Beck Depression Inventory).

• Projective Tests: Rorschach test, Thematic Apperception Test (TAT).

• Neuropsychological Tests: Luria-Nebraska Neuropsychological Battery, Mini-Mental Status Exam.

Observation

• Types:

  • Informal: Clinician observes the client's behavior in natural settings (e.g., halfway house, school).

  • Formal: Structured observations with defined target behavior, antecedents, and consequences (e.g., school counselors observing a child).

• Technology-assisted: Clients can observe their own behaviors using smartphones or devices (e.g., tracking smoking, mood, or social interactions).

Interviews

• Types:

  • Unstructured: Clinician follows the lead of the client.

  • Semi-structured: Clinician has a list of content areas to cover.

  • Structured: Standardized set of questions asked in a specific order (e.g., Structured Clinical Interview - SCID).

• Formats: Can be conducted in person, via email, phone, or audiovisual communication (e.g., Skype, videoconferencing). Visual and verbal interaction is preferred for relationship-building.

Can use more than 1 method

Methods used for Assessment ​

The more methods used, the more balanced the understanding​:

• Eco-map​

• Life chart​

• Genogram / cultural genograms(p.231) ​

• Medicine Wheel ​

• Scaling question ​

• Miracle question ​

• Pre / post assessments ​

• Check Lists ​

• Tests ​

Remember that

• Assessor also being assessed by the client​

• Real understanding involves more than data gathering​

• Multiple perspectives help​

• Remember seeing client at only one moment in time​

A Multidimensional assessment​

• Is comprehensive, far reaching, thorough and an ongoing process​

• The focus of your assessment is always the whole of the person​

• Start with the client’s understanding of the problem​

• Follow the client’s lead​

• Assess the person in the context of their environment ​

• Look for strengths​

• Use separate sections to organize your report​

• The sections will overlap and intersect​

Biopsychosocial model​

• developed by Dr George Engel and Dr John Romana at the University of Rochester in the US.​

• It proposes a very different approach from the traditional biomedical model, in that it considers the behavioural and social elements of a person’s lifestyle alongside the biological.​

• biological, psychological, and social factors

Medicine Wheel

• s interpreted uniquely to each community/tribe. The medicine wheel (also called the Sun Dance Circle or Sacred Hoop) is an ancient and sacred symbol used by many Tribes. It is called a wheel because it revolves endlessly.​

• The Medicine Wheel Teachings are based on the four directions.​

• Look at the person wholistically as a balanced mental, physical, spiritual and emotional being. ​

• At the core of the wheel is strength which we are always looking through the lens of during the assessment, as well as the person in their environment surrounding the wheel and how their environment affects them at the micro, mezzo, and macro levels. ​

• Our questions, queries, and curiosity should come from all of these realms and always be understood in a cultural and environmental context and through a strength based lens. ​

Medicine Wheel​ pt. 2

• Belief that illness is related to more than just the body. The belief is that sickness is related to imbalance. Imbalance is not limited to the physical body but rather it is an extension of all the following four areas - physical, spiritual, mental and emotional. ​

• The Medicine Wheel is both a tool and a guide that promotes healing and wellness. ​

• Everything is connected; all things are related. The approach to wellness is more holistic - one that looks at a larger picture for possible causes and solutions.​

• Historically used all over the world by indigenous people (North America, Africa, Europe, Asia, Australia) ​

• All things are related and all things work together. Such is our overall health - physical, spiritual, mental and emotional. ​

• When you work with this knowledge and place your footsteps in harmony with this ancient wisdom, you will find power.​

Four Areas – Medicine Wheel

1. Mental/Mind/Psychological​

2. Physical/Body​

3. Spiritual/Soul​

4. Emotional/Heart/Social​

Mental/Mind/Psychological

• Learning and using information effectively​

• Being curious and acquiring knowledge​

• Reading, researching, studying, writing​

• Positive attitude, beliefs, values, thought​

• Observing​

• Event/Create​

• Learning a new language​

• Problem solving​

• Playing/listening music​

Physical/Body

• Nutrition and wise food choices​

• Regular doctor/dentist check-ups​

• Proper use of medication​

• Taking necessary steps when ill​

• Safety – seatbelts, helmets, designated driver​

• Absence of toxins – drugs, alcohol, cigarettes​

• Physical activities and fitness ​

• Rest/sleep​

• Stretching (Yoga)​

Physical/Body​ pt. 2

• Elder, Sweats, Smudging ​

• Religion ​

• Good deeds (environment)​

• Acts of kindness/Compassion​

• Making time for higher being daily (driving, walking….)​

• Meditation​

• Attitude of gratitude/Appreciation ​

• Volunteering ​

• Awareness of others losses, hardships, sadness​

We largely accept the need for

food, clothing and shelter (our physical needs) and recognize that we feel (emotional), and that we possess the power of thought (mental), but spirituality is the one thing that people can somehow deny. ​

Emotional/Heart/Social​

• Doing things, you enjoy​

• Good self-esteem/confidence​

• Laughing​

• Express emotions appropriately ​

• Healthy family relationships/Friendships​

• Positive thinking​

• Knowing your worth and abilities​

• Belonging to a group, club, society or committee​

• Purpose driven

Guidelines for Assessment Interviewing​

• Discuss the assessment process​

• Ask how the client perceives the problem​

• Use basic counseling skills​

• Recognize cultural and familial factors affect disclosure​

• Assess the client’s social identities and contexts​

• Assess what’s strong, not just what’s wrong (Cultural strengths)​

• Integrate spiritual and religious questions into assessment​

Conceptualization and Formulation​

• Conceptualization​

• Formulation​

Formulation

• Summary statement​

• Meaning of assessment data​

• Practical guide to future work​

Conceptualization

• Integration and analysis of data​

• On which hypotheses about person’s situation and possible interventions are based​

Conceptualization and Formulation

• Assessment- up close​

• Formulation- bigger picture​

• Often uses multidisciplinary team​

• Putting it all together

Assessment Reports ​

• Avoid speculation​

• Clearly written, no jargon​

• Presenting problems or concerns​

• Previous treatment and effects​

• Client’s background​

• Client’s overall functioning​

• Health or biological conditions​

• History of drug use, abuse, or dependence​

• Brief formulation or conceptualization​

• Strengths and resources​

Clinical Record​

Includes:​

• Assessment data​

• Formulation​

• Treatment plans​

• documentation and permission releases​

• Reports from other providers​

• Reports about client sent to others​

• Progress notes

Goal Setting

Desired outcomes​:

• Short-term goals accomplished quickly​

• Long-term goals take more time​

• Goals should be based on client’s desires for future​

• Build on exceptions to the problem​

Focus on positive goals​:

• Positive goals- what client wants to work towards achieving​

• Negative goals- what client wants to stop doing​

Specific and concrete​:

• Specify behavior to change and settings in which to change it​

Principles of Goal Setting​

• Collaboratively constructed​

• Attainable​

• Involve stakeholders​

• Operationalize into observable behaviors​

• Focus on positive actions, not just elimination of negative​

• SMART​