RAPID ASSESSMENT INSTRUMENTS: TOOLS FOR THE …

1 750 First Street, NE Suite 700 Washington, DC Association of Social WorkersSpecialty Practice Sections 2004 National Association of Social Rights THIS ISSUER apid ASSESSMENT INSTRUMENTS: TOOLS for the AccountableProfessional .. 1 From the Editor .. 2 ADHERE: A Practice Model forEnhancing Client Follow-through with RecommendedTreatments .. 3 Social History Updates .. 7 The Mental Health SectionCommittee Welcomes MarkSmith .. 8A Focus on Ethics .. 9 SPRING 2004 RAPID ASSESSMENT INSTRUMENTS: TOOLS FOR THE ACCOUNTABLE PROFESSIONALSee RAPID ASSESSMENT Instruments, Page 11 Steven L. McMurtry, PhD and Susan J. Rose, PhDIn the current era of managed care, directcontact time with clients is often severelyconstrained, and practitioners face adifficult task in dividing the minutesavailable among such varied tasks asproblem identification, relationshipdevelopment, intervention, and guidingthe client toward termination. In addition,as funding sources requirements foraccountability and quality control in-crease, practitioners must also completeinitial assessments, monitor progress on anongoing basis, and evaluate care methods often seem para-doxical for mental health professionals, inthat they limit client contact time andthus measurement time while mandatinggreater accountability that can be accom-plished only through improved measure-ment.

2 Not surprisingly, considerabledemand has arisen for reliable and validmeasures that can help meet accountabilityrequirements, while maintaining a good fitwith the professional training, treatmentorientation, and time constraints , the number and range ofstandardized ASSESSMENT scales availablefor use in practice and research haveexpanded rapidly in the past 10 to 15years. Brief measures, sometimes referredto as RAPID ASSESSMENT instruments orRAIs, are a particularly fast-growingsubset. RAIs are distinguished from othermeasures by their variety, ease of use,cross-disciplinary applicability, low cost,and, above all, brevity. Most include fewerthan 50 items, some have fewer than 10,and all can be completed by most clients ina relatively brief time often as little asone to five minutes. This allows standard-ized measurement to be a brief part ratherthan a principal component of , many professionals areunaware of these instruments or theirbreadth and diversity. Others know aboutRAIs, but employ them only sparingly dueto lack of information about the types ofmeasures available; how to identify andselect them; how to determine which areconsidered best; how to obtain the RAIsthey wish to try; or because they believe,often incorrectly, that the measures canonly be applied by licensed psychologistsspecializing in psychometric testing.

3 Ourgoal is to provide an overview of RAIs,how they can be used, how they can belocated and evaluated, and how to makethem a tool for enhancing practice ratherthan simply another layer of of RAIsWe define RAIs as empirically testedmeasures with known psychometric2 Spring 2004 Mental Health SectionConnectionSECTION COMMITTEECHAIRB arbara A. Conniff, ACSWP ittsburgh, Sue I. Ka opua, PhD, ACSWK aneohe, Johnson, MSW, LCSWM ilwaukee, WIGwendolyn Strong Scott, ACSW,LMSW-ACP, BCDB ellaire, Smith, ACSW, LISWM arshalltown, SPS MANAGERN ancy Bateman, LCSW-C SENIOR MARKETINGASSOCIATEY vette SENIOR POLICY ASSOCIATELa Voyce Brice Reid, SENIOR ADMINISTRATIVEASSISTANTA ntoniese NEWSLETTER OF THE NASW SECTIONON MENTAL HEALTHM entalHealthSectionConnectionFrom the EditorSee Editor, Page 16 FOCUS ON PRACTICE IN 2004 The strength of social work as a profession resides in its capacity toprovide competent and ethical interventions in sensitive humansituations that frequently occur in complex social professional capacity to meet the challenges in theevolving landscape of mental health services remains the primarypurpose of the Mental Health Specialty Practice Section.

4 In 2004 theMental Health Section Connection aims to address this purposethrough the presentation of practice-relevant on Enhancing Practice-RelevantKnowledgeAssessment and intervention with adult consumers of mental healthservices is the focus of this issue of the Mental Health SectionConnection. Featured are up-to-date descriptions of important anduseful practice technology and models. The contents of this issueinclude: RAPID ASSESSMENT Instruments [RAI]: TOOLS for the AccountableProfessional In this substantive overview of RAI, Drs. Steven and Susan J. Rose, faculty at the Helen Bader Schoolof Social Welfare at University of Wisconsin-Milwaukee,summarize types of instruments, their differential use in clinicalpractice, and resources for obtaining RAI. This groundbreakingcontent is adapted from the authors forthcoming book on RAI. ADHERE: A Practice Model for Enhancing Client Follow-Through with Recommended Treatments This article describes aclient-centered and ecologically oriented model for addressingtreatment adherence, an enduring therapeutic concern of socialworkers across all practice settings.

5 The authors, Lana SueKa opua, PhD, ACSW, LSW, of the Cancer Research Center atUniversity of Hawai i, and Brian Giddens, ACSW, LISW, of theUniversity of Washington Medical Center, developed thisconceptual model through a national collaboration that in-cluded practitioners, educators, and researchers associated withNASW s HIV/AIDS Spectrum: Mental Health Training andEducation of Social Workers Project. Social History Updates describes the consumer-friendly, practitio-ner-friendly system developed by Mark Smith, ACSW, LISW,associate director of Center Associates, a community mentalMental Health SectionConnection Spring 2004 3 See Model, Page 4 ADHERE: A PRACTICE MODEL FOR ENHANCING CLIENTFOLLOW-THROUGH WITH RECOMMENDED TREATMENTSH elping clients adhere to a treatment regimenis a frequently expressed concern of socialworkers in the mental health and healthpractice specialties. To address this concern,ADHERE, a client-centered and ecologically-oriented practice model, was developed bythe NASW HIV/AIDS Spectrum: MentalHealth Training and Education of SocialWorkers Project (2003).

6 ADHERE drawsfrom research in HIV and other chronicillnesses and specifically focuses on interven-tion with psychological, sociocultural, andenvironmental factors associated withadherence, or dedicated follow through witha prescribed regimen (Becker, 1990; DiMatteoand DiNicola, 1982; Ka opua & Mueller,2004; Linsk & Bonk, 1999; Prochaska &DiClemente 1983). Although initially concep-tualized to facilitate support for medicationadherence to Highly Active AntiretroviralTherapy (HAART), ADHERE may offerhelpful considerations to social workers andother healthcare providers involved incounseling and therapy, home health care,and mental health/health case management topersons living with a chronic illness anddesiring to follow through with exercise,dietary, and/or routine clinic visits with a chronic illness is described as unending work and care (Corbin &Strauss, 1988) and adherence to a prescribedregimen is just one of many challenges facingthe client and his or her significant persons living with a chronic illness, atreatment regimen is often open-ended, or ofindefinite duration.

7 Adherence to such atreatment regimen is more difficult becausethe latter often competes with other tasks ofdaily living, including those related to illness,symptom, and pain management, occupa-tional and family responsibilities, and bio-graphical work, or coping with changingperceptions of self in relation to the world(Charmaz, 1991;Corbin & Strauss,1988; Ka opua,2001). In the dailylife of clients andfamilies, adherenceoften involvesincorporation ofnew behaviors intoroutines developedover the course oftime, as well as modification of roles andbehaviors that may be deeply ingrained andculturally patterned. Given the multitude andmagnitude of adherence-related challenges, itis understandable that success in followingprescribed treatment ranges from 20-80%with an average adherence rate of 50%(Gerber & Nehemkis, 1986; Haynes, 1976).Although imperfect adherence is somewhatnormative, certain medical conditions likeHIV require higher levels of adherence toobtain therapeutic results (Ka opua &Mueller, 2004; Linsk & Bonk, 1999).

8 Intervention research indicates that adherenceintent and behavior are associated withknowledge relevant to health recommenda-tions, attitudes about the disease and itstreatment, and sociocultural norms transmit-ted through the family and other groups withwhich individuals identify (DiMatteo &DiNicola, 1982). However, intent to adhere isnot the only factor in following through witha recommended regimen. In the socialenvironment, adherence behavior is power-fully influenced by factors that either enableor disable follow through behavior. Factorsinfluencing adherence include: the extent andnature of social support from natural andprofessional networks, accessibility to healthresources, and the availability of culturallyacceptable, linguistically appropriate careLana Sue Ka opua, , ACSW, and Brian Giddens, ACSWA: Assess knowledge & readinessD: Dialogue about beliefs & : Holistic Approach is : Empower : Reinforce : Evaluate Spring 2004 Mental Health SectionConnectionModel, from Page 3(DiMatteo & DiNicola, 1982; Linsk & Bonk,2000).

9 The ADHERE model identifies sixconsiderations for practitioners assistingclients in treatment adherence at its intersec-tion with mental health and health : Assess client knowledge and readiness fortreatment initiation. ASSESSMENT optimallyresides in a relational environment of col-laboration involving client, significant others,social worker, and other members of thehealthcare team. Because the diagnosis ofHIV and other chronic illnesses may carrysocial stigma and because imperfect adher-ence often has negative connotations, it isimportant for the social worker to communi-cate acceptance for client beliefs, decision-making processes, and treatment involves exploration of client andfamily understanding of the recommendedregimen and is facilitated through the use ofopen-ended, non-confrontational questions,such as: What have you heard about this treat-ment? What do you believe are your options?What do those closest to you believe arethe options? Do you believe that this treatment is do-able for you?

10 What do you think may keep you fromfollowing treatment recommendations?In assessing knowledge and readiness, it isimportant for the practitioner to elicit currentperceptions of health status, beliefs abouttreatment benefits and disadvantages, and toprovide verbal and written information thatis congruent with client s knowledge andunderstanding. Attention to the use oflinguistically and culturally appropriate termsand meanings, as well as explanations thatconsider client s literacy level are critical inensuring mutual understanding of regimenadherence and : Dialogue periodically about health beliefs& illness-related attitudes. Unanticipatedbarriers to follow-through may emerge overtime. Therefore, on-going discussion isnecessary to support adherence to a treat-ment regimen, especially when recommenda-tions must be followed for an indefiniteduration. Communication of empathy andunconditional positive regard for the clientserves as the basis for discussing difficultieswith adherence and lays an essential founda-tion for future discussion of treatmentadherence.