Assessment

Many services undertake assessment as an informal or ongoing process. In order to make decisions and decision-making processes transparent and apparent to service users, assessment can be a very useful tool if structured and seen as a key part of the initial service that you offer.

Outline of Section

What is assessment?

Assessment is the analytical process by which decisions are made. It is the basis for planning what needs to be done to maintain or improve a person’s situation – note that it is not the plan itself. It is gathering the information necessary to make a decision, and, if appropriate, necessary to formulating a care/support plan. Assessment is a dynamic process that can never be total or complete, and should be reviewed both systematically (after one week, one month etc) and on an ad-hoc basis responding to change in the person’s situation.

See Someone and Anyone a research report into assessment in the homeless sector, by Graham Park, published by Homeless Link and the King's Fund in 2002

See also the Assessing assessment information for managers drawn from the findings of the Someone and Anyone research project.

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What will be assessed?

Essentially, we can think about assessing the client’s needs and aspirations, in order to best provide support, and on the other side, about assessing any risks present in order to best protect staff, the client and other clients. Combining the two may make the necessary “risk assessment” more palatable, as a needs and risk assessment (two sides of the coin, like an opportunities and threats analysis).

Assessing the client’s view of his or her own needs is important at this stage too, and can have a dual role in the assessment process – a springboard for discussion, a less confrontational assessment experience and an opportunity to get to know the keyworker (if it is the same person)- an ‘alongside’ approach.

Before the assessment

Communication is key before the assessment as well as during it. Specifically, you need to explain the point of the assessment – to gather the information you need to provide a service. If the assessment ends up in a decision about whether or not the client is suited to your service and whether you will provide them with your service, this needs to be made explicit from the start. Ideally, you should have some kind of appeals process if the decision is unfavourable, and you should let the client know about the existence of such a process as early as possible. Assessment can feel like an interview to be passed or failed, and you should try to minimise this fear. There are many factors to consider in how to conduct an assessment sensitively – but the basic ones should be clear in all cases.

Agree the time, place and duration of the assessment when you make the appointment.
Explain who will be conducting it, (try to consider whether the client will be happier with a man/woman, someone from a similar ethnic background/sexuality/ or has any interpreting needs.)
Explain whether the final decision rests with them or is made by a team or line manager, and ensure the client understands this, consents to the necessary information sharing and is aware of the outcome or decision process and any appeals process.

Many services carry out assessment immediately – to ascertain the client’s suitability for the project for example, but if possible keep this information gathering assessment to a minimum. Think of it as crisis assessment – you do not need a person’s life history at this point, you just need to know their immediate situation. When people arrive at a service it is often after a long day or night, and many frustrations and difficult experiences. They may not be co-operative or able to put themselves forward well at this time. Try to gather only the crucial information, then let them have a rest, get washed/changed, eat and drink something. If they arrive at night, leave the assessment til the morning.

Checklist

Make sure the assessment is to be held in a quiet, private place free from interruptions
Re-iterate the purpose of the assessment – it is to gather information to help you put a care plan in place. It is to ascertain the needs and aspirations of the client, and minimise any potential risks to them having a productive and enjoyable stay with you.
make sure the client is comfortable and has had a cup of tea/cigarette/ i.e. won’t be unnecessarily distracted before time.
Remember that assessments often take place at a time when the client is feeling most vulnerable and least competent. They may feel angry, let down, humiliated, frightened, distressed, depressed or stigmatised. The worker can help by acknowledging and legitimising these feelings but also by making a conscious effort to ensure that the assessment process does not add to negative feelings. You must be non judgemental in asking and responding to some personal information. You may find it helpful to stress the “this is a safe space to talk about your needs and aspirations”

The assessment itself

The following is a non-exhaustive list of areas you will probably want to cover in the assessment.

Some services find it helpful (and empowering to the client) – to use a joint assessment sheet on a point scale, even as simple as 1) have pressing need in this area 2) have moderate need in this area, 3) have no need in this area. The client can judge for themselves, the assessor can judge also, but any difference should be discussed and recorded by whose opinion it is. St Mungo's Star tool works along these lines, and facilitates measurement of the successes of the support plan (soft outcomes).

Good practice is to devise a range of ways of taking and recording the assessment, to take into account of people's preferred means of taking in and disclosing information.

Designing the assessment will depend on the kind of service you run, but these are some common minimum standards.

Getting to know the new resident

For the new resident the admission process can feel a bit like an interrogation. Think about what information is needed straight away, what can be given within the first few days and what can wait until the resident has settled in. The important thing is to make sure that all essential information is collected within an acceptable timeframe.

Be clear about the purpose of the information gathered and, where possible, use observation and information provided on a referral form to reduce the number of questions. Staff should always explain why they are asking for the information, how it will be used and who will have access to it (See also Records and confidentiality).

The main aims of gathering information at this stage will include:

immediate needs assessment (i.e. urgent medical needs)
immediate risk assessment
advice
benefit claim.

Basic information

By the time you get around to the assessment proper, it is hoped services have ascertained the following. If necessary, these facts should be checked, but it is not a natural way to start a meaningful conversation about a person's needs and aspirations. Assessment forms and techniques could confirm this information as a separate sign off sheet at the end of the meeting, incorporating a consent form if the individual expresses interest in linking in with other services.

The reason for requesting each piece of information should be explained to the client. The first few are obvious, the ethnicity monitoring should be explained as such, that the service monitors its accessibility to different people by asking the same questions of all. It is an opportunity to discuss religious affiliation, dietary requirements. Name and address of next of kin,

full name
date of birth
national insurance number
race / ethnic origin

Personal information

The next few items that may commonly be found on assessment forms and induction interview checklists, are questions of a personal nature, that may have difficult responses. It is a mistake to run through a list of such questions in the early stages with a person, but in some ways, they are necessary questions in temporary accommodation. Ideally, this section of the assessment should come after an open discussion. Depending on the worker's knowledge of the resident and their past and personal history, there should be an opportunity for the resident to present themselves, what brought them here, what they are hoping to gain from their stay with the service. This conversation should be informed by the criteria of the assessment form, and the answers to some of the following should present themselves during conversation. Check them at the end or make notes where relevant during the assessment, not as a checklist to note against.

original home area
form of identification
name and address of next of kin
religious affiliation, if any
special dietary requirements.
Disability and medication
most recent housing situation, i.e. sleeping rough, shared accommodation, living with friends and family
if having been recently evicted, ascertain reasons why
medical history and contact with medical services (both mental and physical health)
use of alcohol and drugs
contact with other support services and names of support workers such as social worker or probation officer
whether they have been in the care of social services
previous resettlement history and contact with resettlement services
income, particularly DSS benefits
employment status
whether is ex-offender and current legal status
relations with family and friends.

The interview is also an opportunity to explain fully what services are provided, what is expected of the individual and what rights they have within the project. During the interview allow time for the person to ask questions and seek clarification.

Needs assessment

Areas:

physical health
clothing and hygiene
mental health
substance use
lifeskills – cooking, cleaning, budgeting
interpersonal skills/network

Possible questions:

Are you in good physical health?
Are there any concerns/pains that you would like checked out?
Do you have enough clean, warm clothes etc
Do you have any mental health diagnoses, have you been depressed/anxious, or worried about your mental health? What would you do if you became worried about your mental health? are you on any medication?
Do you use alcohol or drugs? What kind, how often, are you interested in reducing intake etc.
Are you confident cooking and preparing meals for yourself and others – would you like to learn more cookery skills?
Are you happy with your relationships with other people – are you in touch with any friends/family?

The assessment is an opportunity to identify an individual’s coping mechanisms – these may be positive or negative, and future care planning should take into account how a person reacts to stress. “recommendations can be based on existing strengths and preferred ways of working rather than inventing something new and possibly inappropriate.”

Assessment is an ongoing process and it may not be necessary to address all these issues in the first session. Rather, having a wide range of areas to consider in the assessment means that there is a wider scope to identify issues that are important to the client, but may fall beyond the straightforward remit of a housing needs assessment.

We hear a lot about making hostels places of change. Keyworking is all about change, and the assessment is an opportunity to identify areas for change in an individuals circumstances and situation.

A good assessment

starts with an open mind
starts where the individual is
involves and empowers the client as a partner

Formulation

Thinking about and analysing the issues that a client presents with is the second stage in assessment. Once sufficient (and you can never have comprehensive or exhaustive information on someone) information has been obtained, the key to making this intervention the one that creates meaningful change in someone’s circumstances and situation is in formulation.

This is about identifying which aspects of a clients presentation should be addressed first, next and later. The obvious selection criteria should be importance or gravity, but here you will want to look at the client’s motivation to change. Simply put, motivation is highest to change whatever area it is that we want to (that we choose to) first.

A client may have a very serious substance use problem that may preclude lasting success in other change areas but if they are not motivated to change in that area there is little point beginning the conversation about this. Rather, look for areas that will improve the client’s sense of self esteem, well being. These may be simple and easily addressed in the first instance – this is ideal, as successfully achieving something together as a first task will encourage trust and engagement for future, more difficult tasks. Above all, try and be guided by the service user's own preference and sense of urgency, and begin work on the thing that is most important to them. One practitioner tells of a client he knew, who, before he became homeless, had worked as a printer. When identifying areas for action, the client, who had no accommodation and multiple issues around substance use, insisted that the first thing he wanted sorted was to make sure his membership of the National Union of Printers was renewed so that in future, he could return to work. Where possible, and practical, prioritise that which the client prioritises. Big gains in trust and confidence can be made this way.

When formulating and developing the support plan, the client's involvement and ownership of the plan and its rationale are paramount to success. From the outset and the assessment then, encourage the client to think of it as their own plan, not the service's. Some services encourage the residents to keep the master file of assessment, support planning (St Mungos star is a joint ownership approach), while the office keeps a copy.

A useful tool in formulation is the SMART (or SMARTER) models of task planning. Tasks should be Specific, Measurable, Achievable, Realistic and Timeframed.

Specific - goals such as 'feel better about myself' may be the result of lots of little things, in which case you need to be looking at the little things first. Is it specifically - have something to get up for in the mornings? - look after my physical health better? - drink fewer cans in a day? - get in touch with friends/family?
Measurable - how will you know when you feel better about yourself? You may feel ups and downs. But you can measure having something to get up for - enrolling in a class, or attending art workshops at the day centre, etc. Equally you can measure looking after your health better - by number of square meals, seeing a dentist/chiropodist etc.
Achievable - big changes may not be achievable before you have worked on the small issues. It is the myth that 'just get me a flat and it will all be ok'. You can achieve changes in self esteem, motivation, resources, training and opportunities, but start small, especially in the first instance.
Realistic - It may not be realistic to get someone a career as a star footballer. You could however, arrange for a trip to the local team, or stadium for example...
Time-framed - to maintain motivation, and keep a check on progress, goals need to be time-framed. If you say you want to achieve a reduction in drinking say, agree to try and achieve it in the next couple of weeks, and you will look at achievements and obstacles again in two weeks time.

SMART and SMARTER....

E-valuate progress regularly - both at each session (since the last session) and more generally (achievements and changes since the person started attending the centre for example, or since they began keyworking)

... and Re-evaluate!

See the section on keyworking and support planning.

Useful links and examples

St Mungos have created an outcomes star for joint assessment of needs and evaluation of the keywork process. See a briefing on the St Mungos star and a Powerpoint presentation on the St Mungos Star courtesy of St Mungos and Brent Council.

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Created by beth.coyne
Last modified 2007-05-01 02:20 PM

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