This document discusses psychosocial assessment with children and adolescents. It outlines that assessment is an ongoing process that explores biological, psychological, and socio-cultural factors using a biopsychosocial model. It should identify strengths and weaknesses. The assessment process generally includes intake interviews with parents and children, as well as information from collateral sources like teachers. Formal assessment tools and interviews are commonly used. Theoretical orientations help guide the assessment and conceptualization process. The goal is to understand the underlying issues and formulate a hypothesis to guide intervention planning.
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Week 3: Assessment & formulation with children & adolescents
1. Assessment &
formulation with children
& adolescents
Factor-Inwentash Faculty of Social Work
Social Work Practice With
Children & Adolescents
SWK 4620
May 9, 2021
Week 3
2. Psychosocial assessment
• Thinking process that seeks out meaning of case
situations, puts the information in some sort of order, &
leads to a plan of intervention
– Assessments are integral to treatment plans & should
be carried out on an ongoing basis throughout the work
– Exploration of all factors that may contribute to and
maintain problems
– Analysis of interrelationship between biological,
psychological & socio-cultural factors, (Biopsychosocial
Model, Webb, 2003)
– Identification of strengths/weaknesses (risk/protective
factors) (Jordan & Hickerson, 2003)
• Way to avoid jumping from problem to solution without
understanding the mechanisms underlying the difficulty
(Howe, 1995)
3.
4. Who should be part of a child’s/teen’s
assessment ?
Type and order of assessment is determined by
theoretical model of practice
General Guidelines:
1) Intake interview & form completion
2) Parent information/interview
3) Child/teen interview (play/talking, depending on age)
4) Entire family
5) Reports from collateral contacts (teacher, daycare,
pediatrician)
5) Info from or referral to specialized testing
(Psychological, Speech, OT, Audiology)
(Webb, 2003)
5. Common Assessment Tools
Interviews (Structure-Unstructured)
Observations-school or home visits
Categorical Classification Systems (DSM)
Empirically Based Rating Scales (CBCL)
Diagnostic Drawings
Genograms
Ecomaps
Collateral information with consents/releases
History of experiences with other
agencies/service providers
6. Interviews
– Purpose-collect information & develop
relationship/alliance with parents/caregivers
• Parents are major influence on lives of children
– Structured (Interview Schedule for Children) and
semi-structured (Clinical Interview for Children and
Adolescents) or Mental Status Exam
– Collect developmental history
– Important to ask about pregnancy-infancy-early
milestones
– Covers presenting problem, antecedents, strengths,
weaknesses, context
(Jordan & Hickerson, 2003)
7. Interviews
• Some work happens even when setting
up interview
– prepare parents
– set mood
– begin engagement process
– help parents prepare child
8. Mental Health Status Exam
• Very specific and in-depth interview
• Level of consciousness (alert, lethargic, comatose etc.)
• Attention (focus on stimulus without distraction)
• Behaviour (level of activity, affective expression and mood)
• Speech & language (quality, flow, spontaneity, receptive,
expressive, articulation)
• Thought (Circumstantial-wandering, Tangential,
Perseveration, Looseness of association-disorganized, Flight
of ideas-continuous with sudden changes, Thought Blocking,
Neologisms-new words created for emotional reasons)
• Memory (short term, long term, working memory)
• Orientation (time, person, place, situation)
• Judgment and insight (Timberlake & Cutler, 2001)
9. Parent Interview
– Alliance with parent(s) is a must, when possible
– Parents are best source of info. for family history,
developmental history, school history, social
exposure, environmental stressors
– How parents tell stories gives insight into how they
operate & what they value (i.e. sensitivity,
acceptance, pride, joy, fear)
– The use of Genograms or Ecomaps can facilitate
dialogue & enhance the understanding of the family’s
past/present relationships and functioning within an
environmental context.
(Webb, 2003)
12. Interview with the child/teen
• Establishing a relationship is a must
• Be CHILD FRIENDLY (office, dress, mannerisms, goals,
expectations)-but not child-like!
• Consider the child’s developmental level to determine
assessment activity
• Your rapport building should be congruent with the
assessment activity.
• Use your time wisely to find out about the child
• Conservation of questions with young children
(Webb, 2003)
13. Observations
• Unstructured observation time-lots of information
• Waiting room, hallway, entering/exiting room
– Helpful to see “natural” dynamics
– Instruct the child that there is X amount of free time
and can play with toys in many ways.
– Instruct families to interact as they normally might at
home. Remember to place the parent in charge of
safety & give time limit
14. Play-based assessment
• Free play plus:
– Individual Play Genogram
– Sand Therapy (“Make a world in the sand”)
– Color Your Feelings
– Self Portraits
– Kinetic Family Drawings
15. Multiple/collateral informants
• Parent, teacher, physician, standardized
measures, self reports (age dependent),
extended family
• Contact in person, by phone, narrative letter,
questionnaire
• External reports of interest
– Psychoeducational/Psychologist/
Neuropsychologist/Neurologist
– Speech/OT/PT
16. What to look for
In the biological realm
1) brain functioning & maturation
2) biochemistry
3) physical health & development
4) temperament
5) genetic endowment
• Usually determined through
developmental & family history,
observation & collateral reports
(Timberlake & Cutler, 2001)
17. What to look for
In the cognitive realm
--How child uses language, memory,
imagination, problem solving
–Determine representational thought,
symbolic knowledge
–Determine through interaction,
observation, activity and collateral
–School history
18. Gender/sexual development
• Gender development
– Gender/biological sex assignment
– Gender based bullying
– Body image issues
• Sexual development
– Timing/experiences of puberty
– Sexual interests/behaviours/relationships
– Level of sexual activity
– Pornography use
– High risk sexual behaviour
– Generation conflict over sexual development/behaviour
19. What to look for
In the social realm
–History & current relationship functioning
–Number of relationships
–With whom
–How close, quality, structure, affective
tone, sensitivity to others, operational
style (i.e. authoritarian/authoritative),
attachment style (secure, insecure)
(Timberlake & Cutler, 2001)
20. What to look for
In the emotional realm
– Different at each stage of development
– Preschool: what you see is what you get
– School age (latency): may learn to suppress
emotions
– Teenagers: begin to amplify emotions.
– Gender norms exist around emotion
expression
– Determine if emotional coping is ego syntonic
(stress reducing) or ego dystonic (stress
increasing)
(Timberlake & Cutler, 2001)
21. Religion/spirituality/culture
• Identified religion
– Family/child’s involvement
– How issues may be characterized by religion
• Identified culture
– Mainstream/marginalized
– Proximity/access
– Identity with culture
– How issues may be characterized by culture
22. Community/structural
issues
• Family resources/supports
• Housing (quality, stability, safety)
• Network of kin & kith
• Neighborhood/community
connectedness
• Crime/violence
• Local school conditions
• Accessibility of services
23. Categorical assessment system
• DSM-V or ICD-10 or DC:0-3
• Derived from clinician/expert knowledge
• Problems are judged absent or present
• Does not account well for gender or age differences.
• Describes symptoms, features of disorder, age of onset,
prevalence
• Provides a common language
• Low predictive validity, low reliability of classifications
• Social functioning in children not considered
• Comorbidity rates can be high
(Jordan & Hickerson, 2003,)
24. DSM Categorical Clusters
• 1.2Section II: diagnostic criteria and codes
• 1.2.1Neurodevelopmental disorders
• 1.2.2Schizophrenia spectrum and other psychotic disorders
• 1.2.3Bipolar and related disorders
• 1.2.4Depressive disorders
• 1.2.5Anxiety disorders
• 1.2.6Obsessive-compulsive and related disorders
• 1.2.7Trauma- and stressor-related disorders
• 1.2.8Dissociative disorders
25. DSM Categorical Clusters
• 1.2.9Somatic symptom and related disorders
• 1.2.10Feeding and eating disorders
• 1.2.11Sleep–wake disorders
• 1.2.12Sexual dysfunctions
• 1.2.13Gender dysphoria
• 1.2.14Disruptive, impulse-control, and conduct disorders
• 1.2.15Substance-related and addictive disorders
• 1.2.16Neurocognitive disorders
• 1.2.17Paraphilic disorders
• 1.2.18Personality disorders
26. Empirically Based Testing
• Conners’, BRIEF, CDI, MASC, CBCL, ADHD Rating
Scale-IV, WISC, WIAT , ADOS/ADI, BASC, BCFPI
• Problems are scored quantitatively
• Syndromes derived from statistical procedures (factor
analysis)
• Cut points (inclusion or exclusion) are normed to age,
gender etc.
• Sensitive to sub clinical concerns not picked up by DSM
• Comparable scores (T scores)
• Rater reliability can often be problematic
(Jordan & Hickerson, 2003)
• Social Worker’s generally do not test but should know
how to refer for testing, understand results and be able
to integrate findings into Tx planning
(Webb, 2003)
27.
28.
29. Compedium of child and adolescent
assessment materials
• Mental Health Screening and
Assessment Tools for Primary Care
20 pages of assessment tools used in
pediatric care
• https://www.aap.org/en-us/advocacy-
and-policy/aap-health-initiatives/Mental-
Health/Documents/MH_ScreeningChart.
pdf
30. Asking questions
• Not an investigation!
– Open ended
– Clear, direct, developmentally appropriate
terminology
• Normalize when possible
• It’s ok to be silent
• Clients may need time to think or
compose themselves
31. Pitfalls
• Closed, yes/no questions
• Multiple choice questions
• Complex, multi-part questions
• Avoidance of difficult questions
• Pacing too slowly or quickly
• Too much prompting
• Looking for problems when they may
not be there
32. Remember MI skills
• Empathy
• Pacing
• Open questions (how, what, why, tell me
more…)
• Affirming (shine a light on the positive)
• Reflecting (repeat in different words)
• Be curious
• Noticing as a conversation is veering
toward change
• Summarize
32
33. Role of Theory
• Dictates how one views: a child/family, the
problems and how one conceptualizes an
assessment
• Data gathering without theory can be “an
inconsequential exercise in gathering
inconsequential facts”
• Guides intervention approach
(Jordan & Hickerson, 2003)
34. Cognitive Theories
• Information assimilated or accommodated
• Information processing, cognitive distortion
versus deficits
• Piaget’s stages (sensorimotor,
preoperational, concrete operations,
formal operations)
(Jordan & Hickerson, 2003)
35. Affective Theories
• The role of feelings in human behaviour
• ID, Ego, Superego
• Freud’s & Erikson’s Stages of
Development
(Jordan & Hickerson, 2003
36. Learning Theory
• Focuses on acting and behaviour
• Classical Conditioning: natural stimulus
paired with conditioned stimulus—Pavlov
• Operant Conditioning—behaviour is
learned through rewards or punishment—
Skinner
• Social learning—vicarious learning—
Bandura (Jordan & Hickerson, 2003
37. Family Theories
• Children’s problems are related to family
stressors
• Changes within the systems (i.e.
unemployment, mental health) change the
system
(Jordan & Hickerson, 2003
38. Environmental Theories
• Each level of society interacts with and
influences others- Bronfenbrenner
(Jordan & Hickerson, 2003
39. Attachment Theory
• Via attachment relationship the infant
develops an internal working model of self
and others--Bowlby
(Mash & Dozois, 2003)
41. Case Formulation
• Definition: A tentative explanation or hypothesis of the
way an individual with a certain disorder or condition
comes to present at a particular point in time (Weerasekara, 1993)
• Places the child’s problem within the context of his/her
world
• Interpretation/hypothesis about the child’s problem that
explains the symptoms (Timberlake & Cutler, 2001)
• Higher Tx success when Tx plan congruent with client’s
way of operating
• Four P’s of a good formulation
– Predisposing, precipitating, perpetuation, and protective factors,
that look both at the individual and systems associated with the
individual
42. Assessment assignment
• Basic case information: the agency setting, the referral
process, your role and contact with the client and his/her
significant others.
• The client’s (or family’s) presenting concerns: the
precipitating events or circumstances that brought the client
to see you.
• Using an ecological developmental approach (including
biological, psychological, developmental, familial, and
social/cultural dimensions), contextualize the client’s
presenting concerns.
43. Assessment assignment
• This discussion should include risk factors, strengths, and
specific examples of if and how the client demonstrates
resilience in the face of significant adversities.
• Articulate your working hypothesis of the client’s presenting
concerns (i.e., why you think this is happening) and a
theory of change for improving/changing the circumstances
or the client’s response to them (i.e., what you think needs
to happen).
• Integrate course readings or additional materials where
appropriate, but this assignment should reflect your own
assessment and thinking and should not be a research
paper.
44. Possible assessment format
for the assignment
• Reason for referral-context of the referral (agency
details)
• Background-about the client and family
• Developmental history
• Family history
• Manifestation of problem at home, school, community
• Review of theories used
• Tentative explanation of how you understand the
case (formulation)
• Applying theory to information above
45. Class exercise
• Assessment practice
• Groups of 3
– One member is the client
– Other members rotate being social workers or observers
• 30 minute assessment
• 15 minute debrief
– What didn’t get discussed?
– What else do you need to know?
– What do you think is happening for this client?? What do
you think is the context for the central issue?
46. Video (if time we’ll watch in class)
• In Treatment Session 1: Sophie
• https://www.youtube.com/watch?v=M1i
ev0zph3o
• In Treatment: Session 1: Oliver
• http://www.bing.com/videos/search?q=i
n+treatment+oliver+week+1&view=detai
l&mid=C42D1AD566DA834319FFC42D
1AD566DA834319FF&FORM=VIRE1
