Climbing out of the Assessment Rabbit-Hole (pt. 1)

One of the things I struggle with most in practice is my rigid interpretation of the Code of Ethics and Standards of Practice. While this is seen as a good thing by rights of protecting the vulnerable, in the real world the Code of Ethics and Standards of Practice are always depicted as grey, and subject to interpretation that post-modern fans of Foucaultian disposition could appreciate. My dilemma is where the line between evidence-based-practice, assessment, and personal interpretation in assessment intersect. Thus, the inner conflict arises from the fear of imposing an interpretation that is void of empirically-based assessment tools.

Fear not, for practice literature may provide a guiding light for the best direction one can take. For example, the respected Zastrow (2013) defines “assessment” as a process of the “gathering, analyzing, and synthesizing” of “salient data.” So, if we take the most important parts of our interview (which can have evidence-based approaches), observations, and critically reflect on them, there are 5 broad categories that Zastrow (2013) derives:

1. The nature of the client’s concern, which includes the roles clients and their significant others have which contribute to the concern.
2. The client’s level of functioning, which can include strengths, limitations, personality assets, and deficiencies.
3. Motivation of the individual to work on the issue of concern.
4. Environmental factors that contribute to the concerns.
5. Resources that can be used to address the difficulties experienced by the client.

As is true to the profession of social work, Zastrow (2013) includes mention of the preference for these assessments to include the strengths perspective, and other positive attributes that can enhance functioning, resolve difficulties, and promote growth. Furthermore he defines it as an “ongoing process.” This is rightly so, as it is only a judgement at a single moment in time, under a specific set of circumstances. Nowhere is it mentioned that evidence-based tools be used to inform how to proceed. That sounds much less daunting, especially if no evidence-based assessment tools are readily available. So the question becomes why am I concerned about evidenced-based assessment tools?

That is where “structured professional judgement” (SPJ) takes the stage. First introduced to me in the Spousal Abuse Risk Assessment Version 3 (SARA-3) tool, authors such as Regehr (2018) define SPJ as an approach to address risk assessment and risk management. Also referred to as empirically validated structured decision-making, it is only mentioned in the context of using evidence-based guidelines to encourage a systematic and consistent, yet flexible, case-specific means to explore risk. The main features of SPJ tools, as identified by Regehr (2018) are as follows:

1. Items factored in follow a systematic review of scientific research, and consideration of professional and legal literature to a specific population.
2. Guidance on how to carry out the assessment, what factors to consider, and how to rate the factors.
3. Judgements are not determined by a specific scoring or formula, but rather the decision-maker’s relevant weighting of factors.
4. Risk determination is not black-and-white. There can be many different factors that confluence into risk. At times different factors should be disproportionally be considered more important than others, in other circumstances they may not be weighted the same.
5. Conclusions are communicated in a categorical matter (such as low, medium, and high), rather than an absolute score.
6. SPJs are not predictive, but can contribute to prevention. Once risk is determined, the decision-maker may identify specific interventions to manage risk.

What stand out to me from this definition is that evidence-based tools such as SPJ focus on risk. What about when skill-building, and the primary assessment and scope of intervention are not about risk? If you’re assessing, say, John Doe’s ability to plan for developing independence skills of the future, risk is not the immediate concern that may come to mind. The question then is if there is an equivalent to SPJ or empirically validated structured decision-making when the goal is to guide a direction on capacity-building, rather than prevent harm?

A Google Scholar, Sci-Hub, Library Genesis, and Z-Library search did not produce many results. Looking at capacity building, such as working with individuals with neurocognitive and developmental disabilities turned up only SPJ or empirically validated structured decision-making literature on preventing risk (violence or suicide), and, interestingly enough, “supported decision-making” literature for goal work with clients (perhaps focused on the “decision-making” term). At that point, it appeared the construct I was grasping for has not yet matched the academic language needed to find a result.

After a few more searches of social work assessments, came “Functional Behavioural Assessments” (Elswick and Cueller, 2021). While this focuses on the person’s behaviour and its relationship to the environment, it is evidence-based as a strategy to promote socially valued outcomes, rather than having empirically-based interventions to work towards educational/independence skill milestones. It is also noted that social workers play more of a supportive role in the plan, rather than being clinicians creating the plan. Regardless of the level of social work integration in creating the plan, it may have use in directly providing a frame of reference on how we can make links between being evidence-based and working towards desired outcomes.

As there are multiple ideas to this matter to consider, I will return to this idea of evidence-based assessment once I dig a little further into the literature. Of interest is if the types of assessments I am thinking of are specific to qualified individuals of other educational backgrounds. We shall see what part II brings!

References:

Elswick, S. E., & Cuellar, M. J. (2021). School Social Workers Perceptions of the Use of Functional Behavior Assessments. Research on Social Work Practice, 31(5), 503–512.doi:10.1177/1049731521990740 

Regehr, C. (2018). Stress, trauma, and decision-making for social workers. Columbia University Press.

Zastrow, C. (2013). The practice of social work: A comprehensive worktext (10th ed.). Belmont, CA: Brooks/Cole, Cengage Learning.