Children Assessment By Michael E. Woolley

Chapter 1 Assessment of Children

Michael E. Woolley

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Purpose: This chapter details and discusses the historical evolution and current trends in social work in the systematic, ecological, and evidenced-informed assessment of children. It includes the myriad struggles impacting children and the broad range of settings in which social workers serve children and their families. Rationale: Whether in schools, child protective services, juvenile justice, fam- ily or community centers, mental-health agencies, or hospitals, social workers assume many roles in providing services for children. A critical part of providing effective services is a comprehensive assessment informed by social work val- ues, ethics, interfacing with our evolving professional orientation, knowledge, skills, and tools. How evidence-informed practice is presented: One current trend is the increas- ing use of quantitative survey instruments in child assessment, and there is an increasing number of such assessment tools being developed by social work researchers. A second trend is the increasingly widespread need for the eval- uation of the effects of interventions. In order to offer such evaluations, valid and reliable assessment tools are needed that can show changes in the assessed struggles and targeted outcomes of those interventions. Overarching questions: Within specific social work practice settings serving children, in order to complete an ecologically oriented and comprehensive assessment of a child and family, what information would be needed, from whom should that information be gathered, and by what means or methods should that information be collected?

Social workers are vital members of teams delivering services to children across a variety of settings, including, but not limited to, child welfare agencies, family service organizations, schools, health-care providers, and mental-health settings. The struggles and challenges faced by children served by those social workers covers a broad spectrum from day-to- day struggles to life-altering trauma. In all those settings and struggles, beginning the social work intervention process with a systematic and comprehensive effort to gather information about the child, the social contexts of the child, and the presenting struggle or challenge is a critical first step to providing professional, appropriate, and effective services to children who have been impacted by issues ranging from sexual abuse or mental illness to brain tumors or learning disabilities.

Social work has been increasingly called on, from both outside and inside the profession, to demonstrate the effectiveness of its practices. This

1 Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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2 Social Work Practice With Individuals and Families

scrutiny provides the impetus to engage in research to develop evidence- based practice (EBP) strategies and approaches (Gambrill, 1999). The needs for quality assessment tools and strategies as a fundamental task within that effort are twofold. First, all practice activities should start with and be informed by an assessment process. Second, gathering evidence as to the effectiveness of an intervention requires assessing the target of that intervention before and after that intervention is delivered; therefore, reliable and valid assessment measures are a fundamental tool in the pursuit of evidence to support practice.

This chapter first defines what is involved in performing a systematic and comprehensive social work child-assessment process. The accumu- lated social work practice knowledge in the area of child assessment emerging across the first 100 years of professional social work is discussed. We then outline the current prevailing framework used to gather, organize, and present assessment information about children. More recent develop- ments in the assessment of children are then added to that frameworkfor example, the necessity of gathering information from multiple informants and using multiple information-gathering tools when assessing children. Within that evolving assessment framework, a growing effort in social work (and other helping professions) is to strive to utilize evidence-based strategies and tools in practice. What is meant by evidence-based practice and how that effort can inform the most effective and efficient assessment of children is explored. The limitations to the evidence in support of our current assessment strategies with children, as well as promising ways to reduce those limitations, are detailed. Finally, current trends and devel- opments in the assessment of children in social work practice settings, including child protection, schools, and mental health, are presented.

Defining Assessment

Assessment is used to describe an assortment of activities and processes in the social sciences and human services that involve gathering information about a client(s) and the presenting circumstances leading to an evaluation, determination, or plan of action focused on that client or client system. In social work practice, some aspects of assessment are driven by the practice setting, the population being served, and the practice model being applied by the social worker. However, this chapter offers a framework for social work assessment with children that, although embedded within the evolution of the social work perspective and the current effort to situate social work practice on an evidence base, can be applied by any direct practitioner regardless of setting, population, practice level, or model. In this chapter, a descriptive and evolving definition of assessment in the context of providing social work services to children is offered. As a starting framework, assessment in social work with children is defined as including three key components: (1) collecting data, (2) being informed by a contextual perspective, (3) leading to a prevention or intervention plan.

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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Assessment of Children 3

Data Collection

First, assessment of children is, in large part, defined by a range of activities used to gather information about a child, a struggle or challenge confronting that child, and relevant information about that childs social environments. Those activities can include but are not limited to (a) clinical interviews, (b) structured interviews, (c) self-report instruments, (d) direct observations, and (e) reviews of existing records. Those data-collection activities may elicit information from multiple informants, including the child, parents/guardians, other family members, key individuals in the childs life, and professionals who have direct experience with the child.

Contextual Perspective

The second component is illustrated by an enlightening distinction about assessment in social work practice made by Clifford (1998). He referred to social assessment, as opposed to psychological or medical assessment, in that social assessment is centered on a social explanationand will draw on social research and social science concepts in identifying the service needs of an individual, small group, or community. Although social workers clearly also draw on and are informed by psychological and med- ical aspects of and explanations for client struggles, Cliffords focus on the social aspects of the client and his or her struggles distinguishes assessment in social work from assessment in other disciplines. This focus on contex- tual factors in social work can be seen in many assessment orientations in social work, such as the person-in-environment perspective, psychoso- cial models, the widespread use of ecological-systems thinking, and the pervasive structuring of assessment information into a biopsychosocial assessment document.

Prevention or Intervention Planning

Third, child assessment in social work is also defined as having as the central goal in gathering that information to inform the development of a social work prevention or intervention plan to help that child or group of children. Although systematic information about a child and his or her social environments may be gathered for other reasonssuch as part of a research endeavor or eligibility evaluationunless the ultimate goal is a formulation leading to the implementation of a social work service plan, the gathering of that information does not constitute an assessment as it is referred to in this chapter.

Thus, a social work assessment of a child includes (a) data collection, defined as a systematic gathering of information about the child, a struggle or challenge facing that child, and that childs multiple social environments; (b) data pursued from a contextual perspective oriented to how the childs social environments influence the child, the struggle or challenge, and efforts to resolve that struggle or challenge; and (c) development of an

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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4 Social Work Practice With Individuals and Families

intervention plan to assist that child with that struggle or challenge as the primary goal of that data-collection effort.

The application of systemic and comprehensive assessment strate- gies has become more important given profession-wide efforts to build an evidence-based approach to social work services (Gambrill, 1999). Because service-delivery activities start with and are built on the assessment pro- cess, reliable and valid assessment strategies and tools are fundamental to identifying, developing, evaluating, and providing evidence-based inter- ventions. For example, reliable and valid assessments provide a vehicle to evaluate interventions, thereby establishing evidence as to when and with whom such interventions can be effective. Further, the applica- tion of interventions with already established bodies of evidence as to their effectiveness should only be utilized after the application of system- atic, comprehensive, reliable, and valid assessment strategies and tools to inform the selection of interventions appropriate for a specific child in a spe- cific situation. Additionally, the results of a systematic assessment should influence the provision of the interventions chosen, thereby following long-established social work practice principles, such as starting where the client is, treating each client as an individual, and providing individualized services (Hepworth, Rooney, & Larsen, 2002; Pilsecker, 1994).

The wide variety of settings in which social workers serve children, the larger array of struggles and challenges faced by those children, and the wide range of what and who social workers are actually assessingfor example, the child, a potential home placement, the risk of a caregiver to abuse or neglect, the appropriateness of a classroom settingall make a truly comprehensive discussion of assessment of children in social work seem daunting. Therefore, one goal of this chapter is to set the current state of assessment of children in social work in a historical context that encompasses our collective professional knowledge inform- ing the assessment of children as a framework on which to add recent advancements.

Historical Background

Mary Richmond, in her seminal book Social Diagnosis (1917), presents the first comprehensive treatise on the assessment process in social work. Although she uses the term diagnosis, which, for most social workers today means something quite different than assessment, what she is referring to as a social diagnosis 90 years ago meets the three criteria for social work assessment offered here. In fact, for those who have not read all or even parts of her book, it is truly worth the time, and you may find it contains surprisingly still-relevant insights on assessment, social casework, and prescient glimpses of things to come. For example, Richmond describes her preparation to write Social Diagnosis as including systematically reviewing social work case records and recording interviews with caseworkers across five different sites over the course of a year to bring to light the best

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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Assessment of Children 5

social work practice that could be found (p. 7). Is that not an effort to build a body of evidence about what works? Richmond further says of her efforts in the preparation of the book, the most difficult of all my problems has been to make a presentation on the handling of evidence (p. 9) in the assessment process. Richmonds book culminates in a series of structured interview protocols for the assessment of various clients and situations.

Assessment Informing Best and Evidence-Based Practices

The pursuit of providing clients with the best possible social work services available at a given point in time, basing assessment on gathering the best evidence possible, and collecting that evidence in a systematic manner are distinctly not new endeavors in the social work profession. In fact, social work has a rich history of professional knowledge development in the area of assessment.

Central to that accumulation of knowledge in the assessment of children has been the conceptual perspective of a child as embedded in a set of social contexts. Mary Richmond articulated that fundamental perspective 90 years ago. That perspective also guided Jane Addams and the Hull House staff. For example, in the area of juvenile delinquency, Hull House rejected dominant theories based on heredity and instead asserted that the most important factors leading to juvenile delinquency were environmental (Hart, 1990). With respect to assessment, that clearly means the gathering of information about, and analysis of, the social environment that a child inhabits in an effort to understand that childs development, struggles, and behavior.

The history of that perspective can be traced to today by examining social work textbooks over the decades detailing the state of the art and science of casework practices. For example, Hamilton (1951) states that assessment is an attempt to understand the client, the problem, and the situation; and such authors as Perlman (1957), Hollis (1964), and Pincus and Minahan (1973) iterate that triad of assessment. Hollis states this perspective succinctly when she points out that, in assessment, strengths as well as weaknesses in both the person and the situation are important considerations (p. 261). Hepworth et al. (2002) offer a similar triad. Assessment, they suggest, is a process to gather information and formulation of that information into a coherent picture of the client and his or her circumstances, leading to our inferences about the nature and causes of the clients difficulties (p. 187). They do, however, describe a meaningful shift in one aspect of that triad in that they stress the assessment of the needs and the strengths of the client as much as the difficulties of the client. This strengths perspective continues to guide the development of structured assessment instruments for practice, such as a strength-based and culturally informed reliable and valid assessment tool for practice with Native American youth, their families, and communities (Gilgun, 2004). This sort of melding of the long-evolving social work ecological strengths

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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6 Social Work Practice With Individuals and Families

and culturally informed orientation to helping clients with more recent and rigorous assessment methodology seems like a promising trajectory in social work assessment with children.

The focus on strengths has grown in part from the long-standing fundamental humanistic perspective in social work that all clients are doing their best and have resources and that, when clients struggle, it is because of a deficit in those available resources. Such resources can be both internal and environmental, and clients can call on those resourcessocial workers can likewise call on those resources in the assessment processto help meet challenges and struggles clients face (McQuaide & Ehrenreich, 1997). Such a strengths perspective grows out of social works values and ethical orientation to clients (a) as persons of worth, (b) as persons who have a fundamental right to choose their goals in the helping process and how they go about working on those goals, and (c) as persons who are capable of solving their own problems with appropriate support (Loewenberger & Dolgoff, 1985). The strengths perspective also stands in contrast to the still-pervasive medical model of diagnosing and labeling limitations, which is particularly prevalent in mental-health practice (Cox, 2006). The strengths perspective and the focus on the social environments of a client are reflected in the ubiquitous development of an ecological-systems orientation in social work practice.

Evolving Ecological-Systems Perspective

A seminal application of the ecological perspective in social work is the introduction of the life model of practice by Germain and Gitterman in 1980. As they put it, the social purpose [of social work] calls for a practice method that is designed to engage peoples strengths and the forces pushing them toward growth, and to influence organizational structures, other social systems, and physical settings so they will be more responsive to peoples needs (p. 2). In the 1980s, the ecological perspective was increasingly used to articulate the social work approach to assessment and service delivery. Further, some authors started adding concepts from the general systems theory to that ecological perspective to create what was termed the ecosystems perspective (Greif & Lynch, 1983).

The adaptation of systems theory to practice endeavors introduced several helpful theoretical concepts into social work thinking. Those con- cepts are especially helpful in assessment, as they offer insights into how social systemsthe interactions between a client and his or her environmentwork. For example, equilibrium is a concept that states that human systems (read families) tend toward establishing a balance that can be maintained, whether that balance is good or not so good for the mem- bers of the system. Boundaries, such as between members of the family or between the family and other systems, such as the school or neighborhood, are critical in the flow of information, resources, and support within and among systems. Social work has long asserted that assessing and attending

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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Assessment of Children 7

to these dynamic processes are critical to effective assessment of a child and his or her social systems (Germain & Gitterman, 1980).

Another notable step in the evolution of the contextual orientation to assessment in social work is the person-in-environment (PIE) system, introduced by Karls and Wandrei (1992). The PIE system offers a common language and structure for social workers to use in formulating assessments from the unique orientation of social work. One goal in the development of the PIE system was to design an assessment structure that focuses on the social well-being of a client, which is identified as different than physical or mental well-being (p. 81), that assertion being supported by research about those three domains. The PIE assessment approach is sys- tematic and comprehensive and includes information about the client, the problem, and the clients social environment, therefore possessing many of the characteristics described earlier for an effective assessment. It also introduces a coding system for client problems, with codes for duration, severity, and coping, as a way to quantify assessment information. The basic structure of the PIE system includes four factors: Factor 1social role problems, Factor 2environmental problems, Factor 3mental disorders, and Factor 4physical disorders. This system shares some structural char- acteristics with and foreshadows the multiaxial format of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Asso- ciation, 2000) diagnostic format, and, although not widely used today, the PIE system represents an important development in social works quest to build a professionally unique and uniform structure to assess- ment. Additionally, the PIE perspective continues to evolve; for example, the person-environment practice approach, as described by Kemp, Whit- taker, and Tracy (1997), offers an ecological competence-oriented practice model that stresses the importance of ongoing assessment, social support, empowerment, and collective action.

Other developments in social assessment have also yielded systematic formats to gather and organize information. For example, there are two diagrammatic assessment tools that have seen widespread use in social work practice with children and families: the eco-map and the genogram (Hartman, 1995). Both tools grew out of the ecological-systems perspective and gained popularity in social work practice in the 1980s. Either or both can be drawn by a social worker in concert with a child and family during the assessment process and used as tools to elicit and synthesize information from the child and family as they help complete each diagram. Either can then be used to analyze family dynamics, gain a comprehensive picture of the family circumstances related to the struggle or challenge, or used to search for strengths, possible resources, and the ongoing collection of assessment information.

Hartman (1995), a social worker, first developed the eco-map for use in child welfare practice. An eco-map has, at its center, the child and family drawn as a circle (Figure 1.1). Then, surrounding the family and child is a system of circles representing other important people, resources, or activi- ties, such as extended family; friends of the child and parents/guardians;

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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8 Social Work Practice With Individuals and Families

Figure 1.1 Example of an eco-map for Eddie, a 10-year-old boy with behavior problems

Church youth group leader

Father Edward

Chris

Basketball coach

Teacher School

principal

Neighborhood peers

Grandpa Henry

School peers

JessEddie

Sarah

activities, such as recreation, sports, or hobbies; organizations, such as schools, churches, neighborhood groups, or workplaces; or other agencies, such as health-care providers, mental-health providers, or juvenile court. Care should be taken to include not just circles related to the presenting challenge or struggle but also those that represent strengths and resources to the child and family and other struggles or possible barriers to solving the presenting issue. Once all the needed circles have been drawn, various types of lines are drawn between the circles to represent the nature of the connection between the child and family and each particular circle. For example, a solid line depicts a strong relationship, and a dashed line represents a tenuous connection, whereas a line with hash marks across it suggests a stressful connection. Arrows are drawn along the connections to indicate the direction of flow of support, resources, and energy.

Murray Bowen (1978), a psychiatrist who was a pioneer in the field of family therapy, developed the genogram as an assessment tool. Carter and McGoldrick (1980), social workers who have been at the forefront of the evolution of family therapy over the past 25 years, particularly with respect to gender and ethnicity issues, introduced the use of genograms in social work. In drawing a genogram, three or even four generations of the family are depicted (Figure 1.2). Males are drawn as squares and females as circles, and a system of lines is utilized to connect family members and indicate the nature of their kinship. A genogram has levels for each generation, such that family members in the same generation are on the same level across the page. Once all the multigenerational members of

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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Assessment of Children 9

Edward Sr. Died 20 years ago at age 42 Typesetter

Eleanor Loving but can be mean Homemaker

Henry Alcohol problems Bad temper Carpenter

Edith Quiet Teacher

Sarah Nervous at times Had affair that lead to the divorce Teacher

Edward Jr. Abusive Dropped out Truckdriver M1973, D1985

Jessica Can be hyper Good student

Eddie Gets in fights at school Is oppositional with teachers Has trouble sleeping Has periods of withdrawal

Chris Ran away once Older boyfriend

Sheila M1986

62

22

3 1 13

42 35

7

10

70 67

Figure 1.2 Example of a genogram for Eddie, a 10-year-old boy with behavior problems

the family are included and kinship lines are drawn, other aspects of the family dynamics and circumstances can be included, such as marriages and divorces, deaths and illnesses, alcohol or drug use, significant events in the family history, religion, occupation, education, mental-health problems, or any important events or family dynamics. Similar to the eco-map, various types of lines can also be added that characterize the nature of the relationships between family members. A genogram is used in practice not just as an assessment tool to identify family patterns, strengths and resources, and unresolved issues but also as an ongoing tool to identify strengths and resources in intervention planning and implementation. A comprehensive discussion of the use of genograms as an assessment and intervention tool is beyond this chapter; for more detail, see McGoldrick, Gerson, and Shellenberger (1999).

Another important step in the evolution of the ecological perspective in social work is the incorporation of a focus on risk and protective factors and the vulnerability or resilience to the impact of environmental stressors that such factors may offer (Fraser, Richman, & Galinsky, 1999). From this perspective, the characteristics of the physical environment and social relationships may act as risk or protective factors with respect to child and family functioning. Risk factors are environmental characteristics that predict undesirable developmental outcomes, whereas protective factors are promotive of positive developmental outcomes or may compensate for the negative impact of certain risk factors (Richman, Bowen, & Wool- ley, 2004). Central to this perspective is the concept of resilience, which has been defined as the dynamic interplay of environmental, social, and individual protective factors in the context of risk exposure, leading to pos- itive adaptation and desirable developmental outcomes for youth (Luthar, Cicchetti, & Becker, 2000).

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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10 Social Work Practice With Individuals and Families

Related to the concept of resilience, it has become foundational in any assessment process in social work practice to assess client and client-system strengths (Saleebey, 2006). In the assessment of children, that means gathering information about the strengths of the child and the resources available to the child from his or her social environments. For example, Gleason (2007) details a strengths-based approach to completing a social developmental study in a school setting. That approach includes strategies for how to query children about strengths (for example, What are some things you have done that you are proud of?) and how to ask assessment interview questions from a strengths perspective (for example, When things are going well, what does that look like for you?). Then, the social worker frames intervention goals and objectives in positive ways and calls on assessed strengths and resources to achieve those objectives. Finally, a strengths perspective supports social workers striving to give children a voice in school meetings about their school service plans by preparing each child to speak and advocate for him- or herself in such meetings and making certain that time and space are made for the child to make those contributions to the process.

Bringing many of these concepts together in a manner that makes them applicable to assessment with children is the eco-interactional devel- opmental (EID) perspective, as described by Richman et al. (2004). This framework is informed by (a) the ecological-systems perspective in terms of the centrality of the social environment, and (b) the risk and resilience perspective in how that environment influences children, all within (c) a developmental orientation whereby child functioning can only be mean- ingfully interpreted in the context of that childs developmental trajectory and current developmental level, needs, and struggles. Within this eco- logical framework, there are three key environmental contexts that must be assessed in social work practice with children: family, neighborhood, and school. As described by Bronfenbrenner (2005), these microsystems are the environmental settings that directly influence a child, whereas mezzosystems represent the connections among those key microsystems. Examples of mezzosystems include the nature of the relationship between a childs family and a teacher or the relationships between the family and neighborhood residents and organizations. The larger social, cultural, and political environments that children and their families inhabit and the characteristics of those systems constitute the macrosystem.

Social work also has a rich history of stressing issues of cultural and ethnic diversity and historic and current forms of discrimination and oppression that emerge within a familys macrosystem and the various microsystems and mezzosystems surrounding a child and his or her fam- ily. Building on the ecological- and strengths-oriented PIE assessment system described earlier, Appleby, Colon, and Hamilton (2007) have com- prehensively approached the effects of race, culture, and social class in the dynamics of oppression and discrimination (including racism, sexism, homophobia, ableism, and religious bigotry) on healthy development and social functioning. Because a fundamental goal in social work assessment

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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Assessment of Children 11

is to take a contextual perspective, it seems imperative to attend to the impact of such issues with respect to child clients and their families who may be members of currently or historically oppressed or discriminated groups. For example, the authors point out that culture is often seen as static, when, in fact, it is dynamic, changing as it develops, much like an individual develops and changes as the result of interactions with the environment and other cultures. Therefore, the culture in which the child client and his or her family are members is changing, as are the other cultures that child is surrounded by, and the dominant or majority cul- ture, if that is different from the childs culture. Those multiple changing cultural contexts can at once serve as developmental settings for the child and family, sources of strengths and resources, mediators of struggles and challenges, or sources of oppression and discrimination, all potentially profoundly impacting child and family adaptation and functioning.

The pursuit of social justice has become an overarching framework in social work practice that refers to activities to reduce the causes and sequelae on clients, groups, and societies associated with oppression and discrimination. Finn and Jacobsen (2003) have offered a social work prac- tice model that synthesizes well-established practice values, professional ethics, client engagement and professional relationship principles, and the PIE orientation to assessment while focusing on the impact of traditionally unjust structures and processes and the pursuit of socially just outcomes for clients. A comprehensive discussion of the impact on the child-assessment process of social justice issues associated with current or historical oppres- sion and discrimination is beyond the scope of this chapter, so readers are encouraged to consult the literature starting with the references cited here. In fact, much research and intervention development and evaluation yet needs to be done related to the impact of issues of gender, race, ethnic- ity, culture, mental or physical ability, age, socioeconomic class, religion, family structure, sexual orientation, gender identity or expression, and citizenship status on clients and the social work helping process. However, a couple of examples may offer tangible reference points to illustrate that ambitious research and practice strategy development agenda.

In the context of working with Latino clients, Colon, Appleby, and Hamilton (2007) warn that traditional models of social work practice ignore the interdependent, mutually supportive aspects of Latino group norms and individual values (p. 302): for example, the centrality of familism (familismo) in the provision of social and economic support, and the importance of dignity (dignidad) and respect (respeto) in the dynamics of Latino families. Likewise, Colon et al. assert there are important practice implications to the historical racism experienced by African Americans, which today accounts for reduced access to socioeconomic resources, poor physical and mental-health outcomes, and limited access to social services, much of which is maintained by ongoing structural racism, particularly inequitable access to educational opportunity (Orfield, Losen, Wald, & Swanson, 2004). Finn and Jacobsen (2003) suggest that the application of the empowerment approach, an approach with a strong tradition in

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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12 Social Work Practice With Individuals and Families

social work with respect to helping oppressed groups (Gutierrez & Lewis, 1999; Simon, 1994), presents a significant addition to an ecologically PIE- oriented framework to assessment in the pursuit of socially just outcomes for clients.

Identifying and building evidence to support the understanding of the practice assessment implications of such cultural and social justice dynamics that impact children and families require ongoing research efforts. For example, researchers (Ogbu, 1991, 1998; Oyserman, Bybee, & Terry, 2006; Oyserman, Terry, & Bybee, 2002; Woolley & Bowen, 2007; Woolley & Grogan-Kaylor, 2006) have empirically studied and furthered our knowledge (evidence) base about why and how children who are members of historically oppressed and discriminated groups struggle in school and how to reduce long-standing gaps in school achievement for such groups. However, such efforts must find the balance between making broad, or even stereotypical, assertions about members of certain cultural or ethnicity groups and identifying and explicating important cultural patterns impacting social functioning, assessment, and service delivery. The task for individual social work practitioners is to actively seek and synthesize knowledge about the client groups they are serving, from understanding cultural practices and norms to emerging research informing evidence-based assessment and intervention activities.

In sum, an effective assessment of a child in need of social work services requires data about not only the childs struggles, challenges, and functioning and the social microsystemsfamily, neighborhood, and schoolin which that child is embedded but also the mezzosystem cultural dynamics of that child and his or her family along with the current and historical implications of that culture within the wider macrosystemic cultural context. Once such data have been gathered, the information must be organized into a coherent format for analysis and synthesis in order to inform intervention planning. A biopsychosocial assessment offers a format for such organization and synthesis.

Biopsychosocial Assessment Report

Organizing the data collected in a systematic and comprehensive social work assessment of a child involves bringing together these various ele- ments that have evolved with the accumulation of social work practice knowledge. Reflecting the pervasive impact of the ecological perspec- tive in social work, an assessment report of a child is most frequently termed a biopsychosocial assessment (Lukas, 1993), although some authors have referred to it as a psychosocial study (Cooper & Lesser, 2002) or a multidimensional assessment (Hepworth et al., 2002). The outline of a biopsychosocial assessment reflects the social work ecological orientation, including information about various aspects of the child, the present- ing challenge, and the childs environment, that need to be attended to in the developing an effective service plan. Table 1.1 is a suggested

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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Assessment of Children 13

Table 1.1 Biopsychosocial Assessment Outline Identifying Information

Childs name, age, race/ethnicity, physical appearance, religion Childs place of residence, school, other important settings Referral source and referral information

Presenting Struggle(s) Childs definition Parent/guardians definition Social workers definition

History of the Struggle(s) When did it start, how frequently, with whom, and where does it occur? What social, emotional, psychological, learning, or medical/physical risk factors contribute to or are key

factors in this struggle? What are the consequences of the struggle to the child and family? Results from assessment instruments: child reports, adult reports, and structured interviews What attempts have been made to resolve this struggle: By the child or family? With the assistance of professional helpers?

Safety Concerns Abuse or neglect concerns Suicide or homicide risk

Developmental History Current developmental challenges Previous developmental challenges Role of developmental issues in the presenting challenge

Family History Multigeneration background of childs family setting Ethnocultural issues: Acculturation stressors, language concerns, immigration/refugee status Genogram

Strengths and Resilience Factors Childs talents, resources, skills, and protective factors Family strengths, resources, and protective factors Extended family resources Communal resources: Neighborhood, religious organization, ethnocultural organizations Eco-map

Results, Interpretations, and Implications of Structured Assessment Instruments Self-report instruments Adult-report instruments Structured interviews

Child and Family Needs Economic: Income, housing, food, clothing, transportation Social/emotional: Peer interaction, recreation Educational: Appropriate school services Medical: Health care, medication Sociocultural: Translator, cultural specific support, community, advocacy Legal: Guardian ad litem, current court involvement, advocacy

(continued overleaf )

Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a> Created from waldenu on 2021-09-14 03:08:48.

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14 Social Work Practice With Individuals and Families

Table 1.1 (Continued) Mental Status Exam Snapshot of childs social, psychological, cognitive, and behavioral functioning Most often used in mental-health settings (see Cooper & Lesser, 2002)

Mental Health Diagnosis DSM-V Axis Diagnosismost often used in mental-health and other clinical settings; see the DSM-IV-TR

(American Psychiatric Association) Results from mental-health assessment instruments

Initial Contacts with Child and Family Brief description of first meetings and actions taken Childs and familys orientation to the social worker and helping process

Summary Statement A paragraph or two summing up the key information

Initial Service Plan Identify focus of initial service efforts Goals and objectives for those efforts Who will be involved, how, when, and for what purpose?

Note: This outline was adapted from Cooper and Lesser; Fraser, Richman, and Galinsky; Hepworth, Rooney, and Larson; and Lukas.

biopsychosocial assessment outline that reflects the evolution of social work thinking over the past 100 years as it relates to assessment. Some sections will not be called for, depending on the setting for practice, the childs developmental stage, the presenting struggle, and a childs partic- ular circumstances. Further, additional sections may be needed in some situations to address specific issues that are relevant to a comprehensive assessment study of a specific child.

We have reviewed the evolution of the ecosystems perspective informing assessment in social work over the past 100 years: assess- ment tools that have grown out of that perspective, such as the PIE system, genograms, and eco-maps; the recognition of the critical role of issues in assessment, such as cultural diversity and oppression; and the organization of ecological assessment information into a systematic and comprehensive biopsychosocial assessment. These accumulated forms of social work assessment knowledge and strategies with children are still useful today


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