This is the second post in the Casework 101 series by Social Workin It. Read the previous post here: How to nail introductions with your clients.
The assessment process can be a bit overwhelming for students and new caseworkers. It’s not always easy to know which questions to ask, when to go off-script, or even how to react to what you’re hearing. It’s definitely a skill that comes with practice. I promise, it gets easier in time. Hang in there.
To help get you started, here are my top tips for effective case management assessments.
Review the referral information
Typically, case management begins with a referral, which comes with some background information about your client. Your agency may also have electronic client records or paper files with additional information. Before you meet with the person who was referred to you, you’ll want to review this information in detail.
If it makes sense within your role and agency, it’s also a good idea to have a conversation with the person who made the referral to you. This can help you get more nuanced and detailed information than records ordinarily hold. It will also give you a chance to ask questions about the information that was provided so that you are completely clear about the purpose of the referral.
Doing your homework before conducting the initial assessment will give you a better idea of what to expect and how to prepare effectively. This can go a long way to increase confidence and lower anxiety.
Conduct preliminary research
Now that you have a better idea of the presenting issues, it’s a good time to do some background research and resource gathering. Don’t overdo this step, though. It shouldn’t take any longer than 10-15 minutes. In my experience, assessments rarely go the way you expect. You can’t effectively plan for everything. Sometimes the background information wasn’t recorded correctly or was misinterpreted. Sometimes things have changed in the person’s life since the initial contact. Either way, you don’t want to find out that you’ve wasted an hour of your time doing research on resources the person no longer needs. Yikes!
Do a quick review of potential resources, print helpful documents, gather pamphlets, and organize your intake package. Now, you’re ready to meet your new client!
If you haven’t read the first post from the Casework 101 series yet, now would be a good time to do so. It covers the essential components of effective introductions with clients. To summarize the main points:
- Create an atmosphere of warmth, connection, and care
- Build rapport by getting to know the person (and letting them get to know you)
- Introduce yourself and the scope of your role
- Relax and be kind to yourself
You’ll also want to go over your confidentiality policy before you start the assessment, especially any limits to confidentiality. The client has a right to know this information before they reveal anything to you.
Start with the presenting problem
Okay, technically you start by collecting the client’s basic information, such as their address and phone number. However, once you get to the actual assessment questions, you usually start by asking about the reasons the person was referred to you. Allow the conversation to flow from there, using open-ended questions until you have a good understanding of what the keys issues and barriers are.
If you are using a structured assessment form, you may not have a lot of control over the flow of the assessment. I personally prefer a semi-structured approach to the assessment process so that I can gather the necessary information from all clients in the same way and still have the flexibility to adjust the assessment to each person’s particular situation. In either case, it’s important to only ask what is necessary to do your job.
In my experience, a lot of agencies conduct full biopsychosocial assessments when they’re not providing services that would require such a detailed assessment. The challenge is, at best, this puts clients at risk of what I call service burnout, where clients grow so tired of repeating unnecessary information over and over again that they’d rather avoid accessing services altogether. At worst, it puts clients at an increased risk of re-traumatization. Not good in either case.
If you’re a service manager, you may want to review your intake assessment to ensure you’re only asking what’s required. If you’re a caseworker, you may want to bring up any concerns with management and see if there’s an opportunity to update the assessment or, at the very least, if you have some flexibility in how you can apply the assessment to each client’s unique situation.
Apply a social work lens
Asking people questions on a form isn’t something that requires a particular skillset. A computer can do that much. The magic comes in how we apply our lens to the assessment process and the work that follows.
The wholistic lens
One of the key aspects of social work practice is how we use a wholistic lens in the work we do. This is when we look beyond the presenting issues to the interrelated and sometimes unspoken issues that are either impacted by or that impact on the presenting issues. The fundamental question to ask yourself is: “What can I do to ensure this person is better off when our work together is done?” This is often referred to as providing a “wrap-around service” or “continuity of care.”
As an example, in my work as a brief service case manager, I assess each person’s social determinants of health, such as income, housing, and food security, as well as access to medical and mental healthcare. I then look for opportunities to ensure each client is better connected and supported in these areas once our time together is complete. In doing so, I am creating a wrap-around service that is demonstrated to reduce recidivism for the same issues they were experiencing in the short-term and improve overall health and wellbeing in the long-term.
The therapeutic lens
Social workers are equipped with a large and varied therapeutic toolbox. In my experience, our intake assessments are much stronger when these therapeutic tools are intentionally built into them.
As an example, near the end of my assessments, I ask a version of the miracle question. Something like: “If you woke up tomorrow and everything in your life was exactly the way you wanted it to be, what would be different?” Clients understandably find this question challenging. They most often live their lives in crisis mode and have rarely paused to think about how they would like things to be. This question is a therapeutic tool, however, that brings people out of their amygdala and into their prefrontal cortex. In doing so, they leave the fight, flight, or freeze part of their brain and move into the executive functioning part of their brain, which is responsible for things like planning, task initiation, and self-monitoring.
As another example, the very last question I ask is about the client’s personal strengths. Something like: “What is about you that allows you to keep going despite everything your face?” This is another difficult question for folks, as a lot of people struggle with thinking or saying anything positive about themselves. That is why this question is so powerful. It ensures that we wrap up the assessment on a positive note and reminds the person what they are capable of.
While it may seem strange to ask questions that have no obvious purpose, these tools are demonstrated to leave clients feeling less stressed, more empowered to tackle the challenges they are facing, and more prepared to engage in the work that is to come. Now that’s #SocialWorkinIt!
The social work lens also reminds us to meet the client where they are at and to operate from a place of empathy and non-judgement at all times.
Wrap it up
Once you have completed the assessment, the next steps are to co-develop a contract with your client that outlines what you will do together, get informed consent for the work you need to do, and document all the things. And, I do mean, ALL THE THINGS. I will cover each of these topics in more detail in upcoming posts in the Casework 101 series, so stay tuned!
That’s it for the fundamentals of case management assessments. All that’s needed now is practice, practice, practice. So, get out there and start being the fantastic super helper you were born to be!
Disclaimer: Tina Cumby is a Social Worker in Ontario Canada. As such, some of the advice in this article may reflect the particular ethical guidelines for social workers in Ontario Canada. When in doubt, refer to the ethical guidelines of your particular mental health profession and the state or province you are licensed to practice in.
Tina Cumby, MSW, RSW, is an independent writer and creator of free content for mental health professionals. She has been employed as a social worker for four years and has another year of case management and policy development experience. She works primarily with adults living at the intersections of poverty, disability, and trauma at all levels of practice (micro, mezzo, and macro). Tina is particularly well versed in social work case management and student supervision.