Features of a Professional Assessment
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Keywords: aspire model social work, aspire model of assessment
This assignment will focus on addressing the distinctive features of a professional assessment in social work. It will look into the importance of assessment, the assessment process and law and policy which relates to assessment. Finally it will address assessment in practice with regards to two service user groups' namely older people and mental health.
Assessment is part of the foundation of social work practice, the better the quality of assessment the more effective it would be (McDonald, 2006). Coulshed (1991) describes assessment as analysing process of selecting, organising and synthesising information. McDonald (2006) describes it as an intellectual process, it is a tool used to make sense of information relevant to issues examined. Assessment is used in many different forms and with different service user groups, some forms of assessment include; risk assessment, the single assessment processes and mental health assessments. Assessment is essentially identifying the needs and risks in an individual situation to judge which intervention, services and resources would be most appropriate (Adams, Dominelli and Payne, 2009). The 1990 National Health Service and Community Care Act placed the assessment of community care services as statutory work. This enabled social workers to justifiably claim to be doing statutory work, which needed extensive knowledge and to be done quickly (McDonald, 2006). Community care assessment can be a gateway to other services, depending on the level of the patients need.
The assessment process varies between social workers because of their social work experience, theoretical orientation of the social worker, the social workers values and the relationship between service user and social worker (McDonald, 2006).
Social workers also need certain skills to be able to achieve an effective assessment these include listening and communicating skills, being able to counsel and understand a service user's problem, have an insight of other services available to the service user and be able to weigh the risks the service user may face daily against the resources that may be available to the service user (McDonald, 2010) (Harding and Beresford, 1996).
The Victoria Climbé inquiry stressed the importance of assessment (Laming, 2003). If assessment is done properly and as a cycle constantly evaluating Laming (2003) predicts that social work practice and the help given to the family would be more effective. Parker and Bradley (2005) understand that assessment is a continual process and use the ASPIRE model to show how assessment should work. The ASPIRE model stands for assessment, planning, intervention and review and evaluation (Sutton, 1999). This model shows assessment as a process that never stops because service user's situations change over time, reviewing and evaluating the situation and continually reassessing helps to discover if the approach taken is effective or if the service user needs a different one in place. Milner and O'Byrne (2002) have similar recommendations to Laming (2003) they conclude that intervention is more likely to succeed when assessment is effective (Parker and Bradley, 2005).
Within any setting assessment involves a number of features according to Milner and O'Byrne (2002) these include preparation, planning and engagement. The first step involves identifying the main people surrounding the case and then establishing a deadline under which information has to be collected. The next step involves the collection of information. This includes what the individual wants, their problems and information from other sources for example professional statements. The next part of the assessment process involves looking at the data and assessing their needs, by taking into account how they are currently functioning and weighing the risks. The last step involves producing an action plan. This concludes what help is needed, what resources are available and when reviews will take place (Milner et al, 2002).
There are a number of policies and guidance which highlight the importance of assessment and the need for them to be used by social workers. The National Health Service Community Care Act, 1990 section 47: Assessment of Needs for Community Care Services is an essential part of the legislation when assessing an individual's needs. Under this section when it appears that any persons for whom the local authority may provide community care or services or may be in need of any other such services the local authority should carry out an assessment of their needs for those services. Upon receiving assessment results the local authority can then decide whether their needs are great enough to be given provision of services.
Fair Access to Care Services (2003) guidance understands that consistent access to services should be across the country but provision is prioritised into set criteria according to risk and independence. All local authorities have the same eligibility criteria. However they can come to different decisions. This is guidance not law, so any local authority can decide on the scale the individual would be on before services can be given (Clements, 2004).
Features of assessment in relation to older people
The NHS plan (Department of Health, 2000) and the National Service Framework for Older people (2001) introduced the single assessment process (SAP). The aim of this process is to provide person centred care to service users and also their carers. Parker and Bradley (2003) concluded that the government produced this new process because historically there were a number of criticisms involving team working within different disciplines. The SAP was produced to prevent questions being needlessly duplicated by different disciplines and to share the information between all and to ensure person centred care. The National Service Framework for Older People was the first wide-ranging strategy that focused on fair, quality health and social care for older people (National Service Framework for Older People, 2001). The aim of person centred care is to ensure all older people are treated individually, that they receive care appropriate to them. Social workers must also take into account anti discriminatory practice when involved in assessing any individual, the service user's decisions must lead the process. Social workers will have previous experience of the assessment process, and possibly of older people in similar situations, it's imperative that the service user is safeguarded against direction from the social worker to ensure that the social worker does not lead the assessment. The process must focus on the service user's views and perspectives throughout.
The SAP involves three broad levels (McDonald, 2010). Contact assessment, which includes individuals who may need support from different services. Overview assessment involves mental, physical and social needs including the impact of their needs on the family and carers this level supports multi disciplinary teams. The last level is a specialist assessment, taken when more understanding is needed regarding an individual's need and how they can meet it. Another assessment available is a comprehensive assessment. This is offered when the older person needs intensive and long term treatment.
A comprehensive assessment involves basic details, the category of need, the support network the individual has, current problems, carers views, a risk assessment of their current lifestyle, the individuals current strengths, social network and living situation as well as more extensive information.
Assessment uses theory and practice to understand the situations of an older person. It involves problems, risks, needs and resources of the older person. It requires professional judgement to take into account all information to give an opinion, whether the older person needs services and resources to be available for them (McDonald, 2010).
When processing an assessment with older people there are key elements the professional must consider. McDonald (2010) suggests that good quality assessments of older people involve specific components. These include using a strengths perspective, the older person still has the ability to know where their problems lie and how they would deal with them using this throughout the assessment identifies their strengths. Another component includes coping skills, as they grow older they focus more on what they can do and less on what they have difficulties with. Focusing on their strengths rather than problems ensures a positive approach to the assessment process. Social workers must ensure anti discriminatory practice takes place, an important component of this is citizenship, it involves the service user participating in decision making. When moving to a care home for example the older persons care plan should involve advocacy so they can continue to make decisions regarding their health and social care, societal changes and their living environment within the care home. Respecting their decisions is a value social workers should have in practice. Social workers need to understand that family and carers needs may be different to that of the older person and these may need to be a priority. The social worker must also tell the older person about the assessment process giving information about why it's being conducted and what the aim of the process is.
Although the SAP was produced to bring all information together there were criticisms of working with different disciplines. A literature review by Challis, Clarkson, Williamson, Venables, Hughes, Burns and Weinburg (2004) found that there was a lack of trust between disciplines when implementing the SAP. The SAP is a long process and each level takes time that some professionals don't have. Also if the older person is having difficulty they may need to make provisions to enable them to continue with tasks they find difficult until a decision is made regarding resources available to them. However they may not be given the amount of resources and services that the service user expects. Those who are not eligible have needs but are concluded to have not sufficient needs to receive help. These older people are expected to use provisions around them, for example family and friends to help with the problems they face (Henwood and Hudson, 2008). Henwood and Hudson (2008) found that those older people who had sufficient money to fund their services felt that they had to discover their own way to find the right services available, having not received the advice and information that other older people going through the assessment process would get.
Following from the assessment process the older person then receives an individual care plan. This care plan shows the objectives and outcomes from the support provided. The individual care plan builds on the older persons strengths, how they can address their needs, the older person should also agree to the care plan being implemented.
Personalisation is now being introduced in the UK. This new method of assessment involves a self assessment of needs. A Personal budget questionnaire is then completed. This questionnaire is simple and designed to help the older person give information about their needs. The social worker will complete it with the service user and family member. The decision of eligibility is then decided. If they are eligible they will be allocated a sum of money through a personal budget, further assessments would be completed to calculate how much the service user would have to contribute. Once the budget is agreed upon the service user can plan where they want to spend their allocated money on the support they want.
Features of assessment in relation to mental health
There are a number of different assessments which are involved in the mental health services. Depending upon the individual's circumstances specific assessments would take place. Section 47 of the National Health and Community Care Act (1990) states that any individual who has needs of services under a local authority the local authority must carry out an assessment. A decision then follows this assessment. Depending on the mental health of an individual the assessment would focus on their problems and needs and how they could achieve the best outcomes. Standard 2 of the National Service Framework for Mental Health (1999) specifies "that any service user that has contacted their primary health care team with a common mental health problem should have their needs identified and assessed".
Previously the Mental Health Act 1983 and the Common law of necessity have been used to assess the needs of individual with mental health problems. Recently the common law has been replaced by the Mental Capacity Act. Assessors within this service now use a broader approach to include the criteria of both the Mental Health Act, 1983 and the Mental Capacity Act, 2005 (Barber, Brown and Martin, 2009).
Mental health assessment involves a broad scope of information to collect. The Mental Health Act considers the mental disorder, the nature of the disorder, whether the person or others are at risk, the type of treatment necessary for example if the individual needs hospitalisation or if its possible to use community based mental health services and if it's possible to give services without the individual being hospitalised (Barber et al, 2009). It's much less intrusive to the individual if it is appropriate for them to receive care in their community rather than going into hospital and because of the stigma attached to using a section 2 or 3 of the Mental Health Act any social worker or professional in this setting would chose community care if they could.
Assessment with regard to the Mental Capacity Act draws upon information involving the impairment of the individual, the age of the individual, the individual's capacity of making decisions and if the care they would receive would be a deprivation of liberty (Barber et al, 2009).
An assessment under the Mental Health Act can be done compulsorily when there is a mental disorder, or if it is in the patient's safety or health and to protect others. Before the assessment takes place the social worker should look into previous history and liaise with other professionals involved in the case. Depending on whether you use a section 2 which last 28 days or a section 3 which lasts up to 6 months a team is needed to admit the individual. When assessing under these sections the social worker must ask questions regarding evidence of mental illness and the risk towards the individual or others, if the patient consents to informal admission or if there are alternatives to hospitalisation.
A Care programme approach assessment may be offered when an individual leaves an inpatient psychiatric unit or uses a community mental health team. This assessment is encouraged as all aspects of care are co-ordinated by one person. The assessment involves personal history, social situation, description of the illness and symptoms and length of treatment and what the individual's needs are. The care programme approach incorporates four specific elements, as defined in Building Bridges: a guide to arrangements for inter-agency working for the care and protection of severely mentally ill people (DOH, 1995). These elements include the assessment of health care and social needs. The formed care plan, the appointment of a key worker who has a responsibility to monitor the care of the service user and the last element includes regular reviews of the care given and if needed how to adapt the care because of changes of need.
Mental health assessments are complicated because of individual's complex situations assessing risk and needs as well as resources available. Social work practice must encompass a number of strategies when undertaking assessment for it to be effective. The care programme approach enables social workers to focus on the individual directing through all aspects of care and co-ordinating their care when the assessment process is finished.
The social worker is constantly receiving information including guidance from governments, evidence from research and literature. There is only vague guidance on how to undertake the assessment of the individual, even though assessment is so important because the results will undeniably affect the individual's life for the upcoming future for a substantial amount of time. Social workers must balance risk, resources and the individual's needs whilst undertaking the assessment, a process which can be very intricate and complicated when an individual has diverse needs and their risks are so great. However as social workers reflect on their previous assessments they will take away a strong idea of what works and this over time will help make assessments more effective.
Assessment is vital within social work and the features of assessment differ depending on the type of service the social worker is within. However within any service the assessment process still requires similar techniques including individualisation and citizenship and being open and honest. Many reports and papers have shown that when assessment is done correctly and uses an ecological approach which covers society and familial relationships as well as at an individual level then the assessment process will be more effective.
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