Abstract and Keywords
Assessment is an ongoing process of data collection aimed at identifying client strengths and problems. Early assessment models were based on psychoanalytic theory; however, current assessment is based on brief, evidence-based practice models. Both quantitative and qualitative methods may be used to create an integrative skills approach that links assessment to intervention. Specifically, assessment guides treatment planning, as well as informs intervention selection and monitoring.
Jordan and Franklin discuss an integrative skills assessment approach; that is an ongoing process of data collection aimed at understanding clients in the context of their environmental systems (Jordan & Franklin, 2011). Multiple methods should be used to formulate a complete picture of this intricate system; these may include both quantitative and qualitative techniques. Quantitative techniques are methods that allow for operationally defining clients' problems. An example is a scale that gives a numerical score of the client's depression. Qualitative techniques, on the other hand, describe the complexity of clients' problems in more detail. An example of a qualitative measure is a mapping technique such as a genogram. This entry will address assessment as an integrative approach, linking assessment and intervention, and will discuss quantitative and qualitative methods.
An Integrative Skills Assessment Approach
Several practice models have made an important contribution to social work assessment. Jordan and Franklin (2011, pp. 8-35) reviewed early assessment models, including the psychosocial model of Florence Hollis, Gordon Hamilton, and Helen Perlman. The term person-in-environment originated in this approach, and its goal is to determine a client's psychosocial diagnosis. An adaptation of the psychosocial model is the functional approach that deemphasized history and focused on clients' problem-solving ability. These models were based on psychoanalytic theory early on, and ego psychology as the model evolved. Specific techniques used included classical psychiatric interviewing, as well as testing, observations, and interpretations. In contrast, today's assessment has been influenced by brief, evidence-based practice models. Contributors include Eileen Gambrill and Richard Stuart, whose behavioral approaches brought the measurement perspective into social work practice. Hudson (1982) developed a clinical assessment system of computerized scales to easily measure clients' inter- and intrapersonal problems. Kevin Corcoran and Joel Fischer published the first volume of their Measures for Clinical Practice in 1987; this book of measures was designed for use in daily clinical work. In 1995, Jordan and Franklin attempted to integrate qualitative and quantitative approaches to create a comprehensive assessment approach that they referred to as an integrative skills assessment approach. An integrative skills assessment model has these characteristics: theoretical and technical eclectism and a de-emphasis on history, as well as an emphasis on problem and strengths defining, treatment planning, and outcome monitoring. Building collaborative relationships with clients is an important component of the assessment; the qualitative techniques may help with this. Also, collaborative relationships may help the client move successfully from the assessment phase into intervention.
Linking Assessment and Intervention
Today's assessment is an evidence-based approach.
Evidence-based approaches assume that the best evidence is used along with critical thinking skills, knowledge of best practices, and client input (Gibbs & Gambrill, 2002; McNeece & Thyer, 2004). Assessment is an ongoing process beginning with problem (and strength) identification using both quantitative and qualitative techniques.
Qualitative data help the practitioner to understand clients' contextual issues and to establish rapport, while quantitative data may be used to monitor clients' problems and strengths. Monitoring may be structured by using a single subject design approach (Bloom, Fischer, & Orme, 2005). Problems targeted for change are monitored over the course of treatment, usually weekly or even daily. That is, the client completes the same measurement over time so that comparisons may be made to track improvements. These improvements are tracked over the phases of treatment, usually baseline (assessment), treatment, and follow-up. Data are analyzed using a variety of simple statistical procedures. The intervention may be changed if necessary, if the monitory reveals that no progress is occurring.
Moving from Assessment to Intervention
Jordan and Franklin (2002) presented an evidence-based framework for treatment planning with families, including the following steps: problem selection, problem definition, goal development, objective construction, intervention creation, and diagnosis determination. Interventions should logically follow from the problems identified at the assessment (beginning) phase, called baseline. The baseline data indicate the extent and severity of the problem, as well as appropriate outcomes or goals. Following with an evidence-based approach, practitioners search the literature for interventions showing the best evidence at solving the client's particular problem.
Quantitative Clinical Assessment Methods
Quantitative assessment methods provide us with a numerical representation of clients' problems or strengths.
Rationale for Including Quantitative Measures in Assessment
Four reasons help us understand the benefit of using quantitative measures in client assessment (Jordan & Franklin, 2011, pp. 73-76). First, understanding, measuring, and monitoring improve the treatment process. This allows treatment to be changed if no progress is seen. Second, use of clinical research methods allows practitioners to contribute to the clinical practice knowledge base. Third, practice evaluation provides the accountability necessary for managed care and external funders. Fourth, today's practice environment requires social workers to possess greater measurement skills to be competitive with other similar professionals.
Quantitative Methods of Measuring Client Behavior
Examples of quantitative methods that may be used by practitioners include the following: (a) client self-reporting and monitoring, (b) self-anchored and rating scales, (c) questionnaires, (d) direct behavioral observation, (e) role play and analogue situations, (f) behavioral by-products, (g) psychophysiological measures, (h) goal attainment scaling, (i) standardized measures, and (j) projective measures.
Resources and Guidelines
Guidelines for developing a measurement system for assessment include the following: (a) using multiple methods, (b) developing baseline indicators of client functioning, (c) using repeated measures, and (d) using both global and specific measures. A resource for obtaining quantitative methods is Corcoran and Fischer's Measures for Clinical Practice (2005).
Qualitative Clinical Assessment Methods
Qualitative assessment methods seek to understand the meaning of the client system by using contextual techniques and add an extra level of depth to the clinical assessment.
Rationale for Including Qualitative Measures in Assessment
Qualitative techniques such as biographical narratives, interviews, or experiential exercises seek a holistic understanding of the client. Five unique contributions that qualitative assessment measures bring include, first, the ability to uncover realities that would be missed when using only quantitative approaches (Jordan & Franklin, 2011, pp. 127-130). For example, a client may be asked to keep a diary to add context to her standardized measurement recording her depression. Second, the standardized instruments used in quantitative assessments have limited usefulness for people of color. Qualitative assessments offer open-ended process-oriented techniques to access clients' cultural scripts and meanings. Third, qualitative assessments promote practitioner's self-awareness and therefore a positive therapeutic alliance. Fourth, the holistic nature of qualitative assessment encourages a reciprocal client-social-worker relationship. Finally, a fifth rationale relates to qualitative technique's fit with many theoretical and therapeutic perspectives, including family systems, ecosystems, cognitive-constructivist, feminist therapies, and so forth.
Qualitative Methods of Measuring Client Behavior
Qualitative methods include ethnographic interviewing; narrative approaches such as process recording, case studies, and self-characterization; repertory grids; graphic methods; and participant observations.
Resources and Guidelines
Validity and reliability are very important in qualitative assessment and rest on the credibility and completeness of the data collected. Questions to ask include the following: Were multiple measurements used? Does the information tell the whole story? Do the conclusions drawn make sense? Are there any unexplained gaps? and so forth. For a resource, see Deborah Padgett's The Qualitative Research Experience (2003).
Assessment is an ongoing process whereby qualitative and quantitative assessment methods may be used together in data-gathering. The use of multiple methods is necessary to improve the reliability and validity of clinical information. Specifically, qualitative methods may enhance the clinician's understanding of the context within which problems occur, while quantitative methods provide information on the specific nature of the problem. The assessment then informs treatment planning and guides intervention selection.
With the increasing emphasis on evidence-informed practice, assessment is certain to latch on to this broader definition as well. Evidence-informed practice is defined by the Institute of Medicine as consideration of research evidence, clinician expertise, client values, in addition to contextual variables in clinical decision-making. Adding contextual variables to the assessment equation gives a meatier picture of the client-in-situation, taking us as social workers back to our roots.
Bloom, M., Fischer, J., & Orme, J. (2005). Evaluating practice: Guidelines for the accountable professional (5th ed.). Boston: Allyn & Bacon.Find this resource:
Corcoran, K., & Fischer, J. (2005). Measures for clinical practice. New York: Free Press.Find this resource:
Gibbs, L., & Gambrill, E. (2002). Evidence-based practice: Counterarguments to objections. Research on Social Work Practice, 12(3), 452-476.Find this resource:
Hudson, W. (1982). The clinical measurement package. Homewood, IL: Dorsey Press.Find this resource:
Jordan, C., & Franklin, C. (1995). Clinical assessment for social workers: Quantitative and qualitative methods. Chicago: Lyceum Books.Find this resource:
Jordan, C., & Franklin, C. (2002). Treatment planning with families: An evidence-based approach. In A. Roberts & G. Greene (Eds.), Social worker's desk reference. New York: Oxford University Press.Find this resource:
Jordan, C., & Franklin, C. (2011). Clinical assessment for social workers: Quantitative and qualitative methods (3rd ed.). Chicago: Lyceum Books.Find this resource:
McNeece, A., & Thyer, B. (2004). Evidence-based practice and social work. Journal of Evidence-Based Social Work, 1(1), 7-24.Find this resource:
Padgett, D. (2003). The qualitative research experience. Belmont, CA: Wadsworth.Find this resource:
Hoefer, R., & Jordan, C. (2007). Missing links in evidence-based practice for macro social work. In M. Roberts-DeGennaro (Ed.), Journal of Evidence-Based Social Work.Find this resource:
Walter W. Hudson's WALMYR Publishing Co.-Assessment Scales. http://www.walmyr.com/scales.html