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The Assessment Process in Child Welfare Practice Agencies and Courts Conference Washington, DC August 3-6, 2009 PowerPoint Presentation
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The Assessment Process in Child Welfare Practice Agencies and Courts Conference Washington, DC August 3-6, 2009. What is Assessment? . Defining Assessment.

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The Assessment Process in Child Welfare PracticeAgencies and Courts ConferenceWashington, DCAugust 3-6, 2009
defining assessment
Defining Assessment

A useful evaluation cannot be part of an assembly-line process, and instead must be the considered summation of an evaluator's intense contact with a unique child/youth and family at a critical moment in time.

defining assessment4
Defining Assessment

A useful evaluation should build on child/adolescent and family experiences and include thoughtful, individualized recommendation. Therefore, it is appropriate that the key aspects of the evaluation process (interview, written report, and recommendations) are also grounded in an ethical perspective of good child welfare practice

elements of assessment
Elements of Assessment

A complete Family-Based Assessment ideally

encompasses the following elements:

  • a complete bio-psycho-social assessment
  • a full five axis psychiatric evaluation
  • a complete WAISC psychological evaluation
  • a physical health care assessment
  • an educational assessment
  • a life skills assessment
assessments initial and continued case planning
Assessments:Initial And Continued Case Planning

Identifying Information:

  • Identifies family and household members, including each biological parent, stepparents, siblings/half-siblings. Identifies marital status of parents, and nature of child's contact with a non-custodial parent. Identifies employment status of current parental caregivers. Identifies custody of the child, and child's legal status (e.g., adjudicated or not).
assessments initial and continued case planning7
Assessments:Initial And Continued Case Planning

Identifying Information:

B. Identifies other team members, including involved professional agencies/systems (e.g.,child welfare workers, juvenile justice, case management, child psychiatrist, special education, etc.) and community supports.

assessments initial and continued case planning8
Assessments:Initial And Continued Case Planning

Reason for Referral:

  • Determine medical necessity for initial care or continued care service request.
  • What are there specific safety related issues?
  • Identify additional purposes, as relevant (e.g., monitor medication, respond to crisis).
assessments initial and continued case planning9
Assessments:Initial And Continued Case Planning

Relevant Information: (begin with Brief Update, if a continued care request)

Strengths:

Child/adolescent strengths, in multiple domains.

Special attention to motivation and ability to form relationships and use support.

Areas of greatest competence and independence.

Family (including birth family) and community strengths.

assessments initial and continued case planning10
Assessments:Initial And Continued Case Planning

Relevant Information:

  • Concerns:

Clinical basis for current service request and recommended treatment.

Nature, frequency, severity, and history of the child's behaviors/symptoms

Identification of both externalized behaviors and internalized symptoms, comparing present to past.

Other identified needs and concerns.

assessments initial and continued case planning11
Assessments:Initial And Continued Case Planning

Relevant Information:

  • Family:

Family composition (including relevant extended family and birth family), family relationships, strengths/concerns.

For child in substitute care, foster family and natural family included.

Family cultural and spiritual beliefs and practices, as relevant.

Family history of psychiatric disorder, as relevant.

assessments initial and continued case planning12
Assessments:Initial And Continued Case Planning

Relevant Information:

  • School/Vocational:

The child's academic, social, and behavioral adaptations, including relationships with school peers and with teachers and/or level of functioning.

Efforts to date of school to address current problems. Characteristics of current class setting

Current or past use of school-based services, if relevant.

Current or past educational testing, and IEP.

Prior school placements.

assessments initial and continued case planning13
Assessments:Initial And Continued Case Planning

Relevant Information:

  • Community:

Place of residence-family home or apartment, group home, RTF, etc.

Community activities and attachments.

Use of leisure time.

Community employment, current and in past.

Degree of church/mosque/temple or spiritual involvement.

Nature of neighborhood, in terms of resources and culture, safety, specific conditions.

Specific stressors, as relevant.

assessments initial and continued case planning14
Assessments:Initial And Continued Case Planning

Relevant Information:

Peer Relationships:

Patterns of peer relationships in the neighborhood and in school, including similarities and differences between the two settings.

Predominant age of peers-same-aged, older, or younger-and gender of relationships.

Predominant activities with peers, formal and informal. Nature of peer culture.

assessments initial and continued case planning15
Assessments:Initial And Continued Case Planning

Relevant Information:

Drug and Alcohol:

Child's current use/abuse of drugs and alcohol-type, frequency, severity.

Child's past history of use.

Child's past drug and alcohol treatment, response to treatment, involvement in self-help groups.

Family substance abuse history.

assessments initial and continued case planning16
Assessments:Initial And Continued Case Planning

Relevant Information:  

Medical/Developmental:

Medical illness, acute or chronic infection, physical limitation, brain or other injury, past surgery, pregnancy.

Lead or other toxicity.

Medication allergies as relevant.

Developmental history: pregnancy, delivery, neonatal period, developmental milestones.

assessments initial and continued case planning17
Assessments:Initial And Continued Case Planning

Relevant Information:

Medical/Developmental:

Developmental history: pregnancy, delivery, neonatal period, developmental milestones.

Trauma history: neglect, physical abuse, or sexual abuse.

Gender/sexual orientation, when relevant and with consent of the child, and other issues of sexuality.

assessments initial and continued case planning18
Assessments:Initial And Continued Case Planning

Relevant Information:

Legal Custody

Adjudication as delinquent or dependent.

Other delinquent status indicators: probation, placement in juvenile facility, incarceration.

Outstanding legal issues for family: pending charges, community service requirement, other.

assessments initial and continued case planning19
Assessments:Initial And Continued Case Planning

Service History:

Services used in past, reason, level of participation, and effectiveness. Include all levels of care, psychotropic medication, out-of-home placements (mental health and other), and services from other systems.

assessments initial and continued case planning20
Assessments:Initial And Continued Case Planning

Interview:

Identification of participants.

The child/adolescent's appearance, hygiene, self-care.

The child/adolescent's manner of relating to the interviewer and other identified adults present. Emphasis on level of engagement, cooperation, openness to input.

assessments initial and continued case planning21
Assessments:Initial And Continued Case Planning

Interview:

The child/adolescent's formal mental status. Include verbalized goals, needs, requests, response and commitment to treatment, degree of understanding and insight, other individualized ideas of the child/adolescent, and ability to contract for safety, when relevant. Compare with previous contacts, if applicable.

Key issues/themes addressed, and areas of agreement/consensus.

assessments initial and continued case planning22
Assessments:Initial And Continued Case Planning

Interview:

Discussion:

Overview/summary.

Hypothesis/formulation.

Diagnostic considerations.

Rationale for recommended services.

assessments initial and continued case planning23
Assessments:Initial And Continued Case Planning

Interview:

Nature of consensus and agreements with the child/adolescent, family if present, and others.

Reliability of the informants

Prognosis.

assessments initial and continued case planning24
Assessments:Initial And Continued Case Planning

Recommendations:

Identification of each specific behavioral health service recommended, listing the amount, duration, and scope of each.

Other treatment recommendations, both global and specific (e.g., other needed services and interventions for the team to consider; psychotropic medication referral or recommendation; additional recommended assessment(s); community referral(s) and natural supports; education and/or vocational recommendations; consultation with primary care physician; other).

assessments initial and continued case planning25
Assessments:Initial And Continued Case Planning

Recommendations:

For continued care requests, criteria for service tapering or modification of level of care, and recommendations to increase natural supports.

How to link recommendations with treatment goals and then evaluate treatment goals.

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Louisiana’s Approach to Comprehensive Assessment

What prompted this initiative?New AdministrationConsultant help following hurricanesComprehensive system reviewOur state put into place many new and improved services, but this was the most important “service” of all.

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Louisiana’s Approach to Comprehensive Assessment

We recognized two important things:

(1) Due to increase in worker turnover, we had much less experienced staff, and staff with less relevant education and preparation for this work; and

(2) Even among those who had been in the system awhile, we had created a compliance mentality rather than one of critical thinking

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Louisiana’s Approach to Comprehensive Assessment

Goal:Increase staff education and skill in core practice areas

Increase reliance on evidence supported tools and practices

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Louisiana’s Approach to Comprehensive Assessment

The Process:

Focus on Four: A conscious decision and commitment by agency management to increase staff competence and support to focus on the four primary responsibilities of child welfare professionals:

1. Assessing safety2. Assessing risk3. Assessing family functioning4. Case planning and assessing progress

slide30
Louisiana’s Approach to Comprehensive Assessment

Implementation Plan

Strategically planned to follow AR rollout

Established partnerships (NRC’s, court improvement personnel, SDM)

Communication plan: field staff, stakeholders

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Louisiana’s Approach to Comprehensive Assessment

Policy:

IT:

Training: Initial and on-going

Looking back:

What worked well?What we would do differently.

QA

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Rhenda H. Hodnett, MSW, LCSW

Director Prevention & Protection ServicesDepartment of Social Services

Office of Community Services

627 N. Fourth Street, P. O. Box 3318Baton Rouge, Louisiana  70821225-342-4013

rhodnett@dss.state.la.us

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Gerald P. Mallon, DSW

Professor and Executive Director

The National Resource Center for Family Centered Practice and Permanency Planning

Hunter College School of Social Work

A Service of the Children’s Bureau

129 East 79th Street

New York, New York 10075

(212) 452-7043

Gmallon@hunter.cuny.edu

www.nrcfcppp.org