Process Of Social Work Assessment/diagnosis

Front 1

Diagnosis

Back 1

The process of identifying a problem and its underlying causes and formulating a solution.

One of three processes:
Diagnosis
Social study
Treatment

In addressing the diagnostic process, the diagnostic product must be obtained.

Front 2

Suggestions about Diagnosis

Back 2

Corey (2001) suggested that certain questions be asked:
What is happening in the client’s life now?
What does the client want from therapy?
What is the client learning from therapy?
To what degree is the client applying what is learned?


Carlton (1984) stressed the importance of recognizing three factors:
The biomedical
Psychological
Social
Balance must be obtained between these factors.
The area of emphasis can change.

Front 3

Diagnostic Product

Back 3

Life stage
Health condition
Family/other membership
Racial/ethnic membership
Social class
Occupation
Financial situation
Entitlements
Transportation
Housing
Mental functioning
Cognition (personal)
Cognition (capability)
Psychosocial elements

Front 4

Assessment

Back 4

According to Baker (1995), assessment involves “determining the nature, cause, progression, and prognosis of a problem and the personalities and situations involved”.
Also, it involves understanding and making changes to minimize or resolve a problem.
Requires thinking and formulating from the facts within a client’s situation to reach tentative conclusions regarding their meaning.
Viewed as an essential ingredient to start the therapeutic process as it becomes part of the interaction between the client and therapist.
Assessment controls and directs all aspects of practice, including: nature; direction; and scope.
Assessment and diagnosis cannot be separated.
Must be continually updated as part of the intervention process.

Historically, assessment has been referred to as diagnosis or the psychosocial diagnosis.
They are not interchangeable.
Diagnosis focuses on symptoms.
Assessment is broader and focuses on the person-in-environment stance.

Front 5

Assessment Considerations

Back 5

Examine carefully how much information the client is willing to share and the accuracy of that information.
As accurate a definition of the problem as possible need to be gathered as it will not only guide the diagnostic impression, it will also guide the approach or method of intervention that will be used.


All professional practitioners need to be aware of how their beliefs can influence or affect the interpretation of the problem or both.
Issues surrounding culture and race should be addressed openly in the assessment phase to ensure that the most open and receptive environment is created.


The assessment process must focus on client strengths and highlight the client’s own resources for addressing problems that affect his or her activities of daily living and for providing continued support.
It is expected that the professional will gather information about the present situation, a history of past issues, and anticipate service expectations for the future.

Front 6

Biomedical Factors

Back 6

General medical:
The physical disability or illness the client reports
What specific ways it effects the client’s social and occupational functioning and activities of daily living.
Perceived overall health status:
Encourage the client to assess own health
Assess what they can do to facilitate the change effort.

Front 7

Psychological Factors

Back 7

Mental functioning:
Describe the client’s mental functioning.
Complete a mental status exam.
Learn and utilize the multiaxis assessment system
Cognitive functioning:
Ability to think and reason?
Able to participate and make decisions?
Assessment of lethality:
Harm to self or others?

Front 8

Social/Environmental Factors

Back 8

Social/societal help-seeking:
Open to outside help?
Support system? Family? Community?
Occupational participation:
Impairment prohibits functioning?
Supportive work environment?
Social support:
Neighbors? Friends? Community?
Family support:
What support or help can be expected?
Ethnic/religious affiliation:
Membership? Help or hindrance?

Front 9

Important Considerations

Back 9

The problem must be recognized and linked to interference of daily functioning.
Consider environmental context in which the behaviors are occurring.
Cultural considerations for both the client and the practitioner should be addressed and discussed openly.
More than an impression, it involves utilizing the information to best help the client.

Front 10

Multi-Axial Classification System

Back 10

The first two axes are used to present the clinical disorders actually listed in the manual.
Axis I lists the majority of mental disorders.
Axis II is reserved for persistent or chronic conditions.
The separation is intended to assure that more chronic conditions are not overlooked.

The diagnoses are listed in order of their importance to the person’s social functioning.
In instances where there are diagnoses in both Axis I and Axis II, it is assumed that Axis I is the principal diagnosis unless Axis II specifically labeled as such.
DSM allows for communicating the level of uncertainty regarding a particular diagnosis.

Axis III is designed to present general medical information.
Do not diagnose a general medical condition.
Only conditions reported by client; listed in a clinical record or reported by a physician.

Axis IV is designed to present specific information about the client’s current psychosocial environment.
A number of global categories of problems are suggested in the DSM text.
Practitioners are encouraged to include specific information on Axis IV in addition to such global characterizations.

Global Assessment Functioning (GAF) score is listed on Axis V.
This 100-point scale is presented in DSM.
In some situations, an individual’s functioning can be at very different levels depending on which aspect is emphasized.
It is recommended that in those instances, the client’s potential for danger to self or others should take precedence in determining the GAF score.