Some thoughts on clinical social work assessments

Your blog is a great resource. I have a question and was hoping you’d give me some insight. I’m a clinical social worker. In most places I’ve worked, I’ve had to do assessments. Even with the most neutrally-worded assessments, clients often become offended or embarrassed by at least one of the questions, with topics ranging from sexuality to family to criminal history. It pains me to ask people invasive questions, but sometimes they’re necessary. Any tips for breaking through this?

realsocialskills said:

I don’t have a good answer to this - assessments definitely create a lot of problems for pretty much everyone who has to do them. I have some theories, but they’re very tentative at this point:

Don’t see the assessment as an end in itself:
  • Some people believe in assessments with an almost religious fervor
  • But your work isn’t about doing assessments, it’s about serving your clients
  • The assessments are a means to an end, and keeping that in mind helps
Think about the purpose the assessment is serving (I can’t tell you in detail what to do with your conclusions, but keeping the purpose in mind can be helpful):
Is it giving you information that you or others on your team need to have in order to serve this particular person?
  • eg: In a medical office, team members need to know if someone has a latex allergy.
  • And in most contexts, people need to know if someone is a minor
  • It can also be important or helpful to know family members or emergency contacts.
Do you need the information for specific reasons, or is it about generally rounding out the picture of who this person is?
  • For instance, you might routinely ask someone where they grew up in order to get a sense of their background
  • But you might not actually need to know that for a particular purpose
  • These might be the kinds of questions that you stop asking if someone isn’t receptive to them, even if they’re often helpful with other people
Is it for the purpose of assessing demographic uses of your services?
  • For instance, an agency keeping data on equity in its services might want to ask people about race, sex, gender, national origin, disability, or sexual orientation in order to assess whether they’re providing services in an equitable way
  • These are all things that in *some* social work contexts can be important to know about individual clients, but in other contexts they’re not pieces of important information
  • For instance, a food pantry might want to keep data on race in order to determine whether people of all races have good access to their services, but they don’t need to know the race of a specific person in order to serve them
  • These, too, might be questions you don’t press sometimes
Does it serve some other research purpose?
  • For instance, if your agency trying to determine whether using one kind of consent form works better than another?
  • There are a lot of rules for research
  • I don’t know them well
  • But I think it’s important to notice when what you’re doing is research, even when it’s undeclared research (which shouldn’t happen but does)
Is it information you’re required to gather even though having the information serves no actual purpose?
  • It is very common for agency assessment forms to have questions or even whole sections that serve no purpose as far as anyone on the team can tell
  • It’s ok not to take these sections very seriously
  • You don’t have to pretend things are important when they’re not
  • That said, things can be important even when most people in power don’t take them seriously
  • So know for yourself which things you consider importance
Is it a matter of creating a paper trail for the purposes of legal compliance?
  • It’s important that paperwork comply with the law
  • But things done for the purposes of legal compliance do not necessarily need to be treated the same way as things done because you actually need the information
  • It depends on the situation

Are you trying to determine eligibility for services?

  • That tends to involve uncomfortable or even illegitimate questions
  • Which you tend to have to ask anyway
  • I think it’s important to know when questions are and are not necessary for this purpose
Is it information that is actually needed to protect the safety of clients?
  • For instance, if you’re trying to detect red flags for abuse, those might be questions to push more
  • Or if you need to know about drug use for safety reasons (eg: if a drug commonly recommended to treat an issue interacts with a commonly used illegal drug, knowing that person’s drug history might be important)
  • Or if a treatment can be harmful to a fetus or dangerous to a pregnant person, it’s important to know if that person is pregnant or likely to become pregnant
Be honest with the person you’re working with. If you need the information, tell them why. If they don’t have to answer the questions, tell them.

When you’re asking sensitive questions, it might help to be explicit about the fact that you have to ask everyone:

  • Because otherwise people will think that you are asking because you suspect something about them
  • This is particularly important if the thing you’re asking about is stereotypically associated with their group
  • (As it is likely that the stereotype has been used to belittle them or justify violence or denial of important services; hearing this question from a social worker can be really loaded even if you have the best of intentions. They can’t read your mind, and you might sound just like people who do not mean well when you ask that)
  • But don’t mock the idea that it might apply to them. Because it might, and you don’t want to prevent them from giving you that information, or to imply that it is shameful 
Respect the people you’re working with, and take the power dynamic involved seriously:
  • By the time someone gets to a clinical social worker, they’ve probably already lost a lot of autonomy and power
  • And they’ve probably been dealing with people they can’t say no to
  • And all kind of people invading their privacy on all kinds of levels
  • If they can say no, *make that clear*.
  • If you have to ask but they don’t have to answer, *tell them it’s ok not to answer your questions*.
  • It might be worth acknowledging that it’s uncomfortable and invasive
 Keep in mind that people have the right to be offended:
  • Don’t try to get them to tell you it’s ok
  • It might not be ok
  • And they’re allowed to be angry that a stranger is asking them a lot of invasive personal questions
  • It might not be your fault, but it’s not their fault either
  • Part of your job is to accept that some people you work with are going to be legitimately angry or offended
  • The skills for dealing with that can be hard to aquire
  • But it’s not ok to evade it by putting pressure on people to tell you it’s ok when they think it isn’t
  • This is something all social workers and people in related fields are at risk of falling into (particularly if you are at the bottom of your professional hierarchy and feel powerless because you are forced to follow policies you disagree with)
  • Even if you feel powerless in your work, it’s important to remember that you are exercising tremendous power over other people
  • At the end of the day, you get to go home and have a life outside of any social services involvment
  • People who depend on services don’t
  • Don’t forget that, and don’t pressure them into making you feel better. Your self-image is not their problem.

Does any of that help?

And do any of y'all with experience in either asking questions as a social worker or being asked questions by a social worker have thoughts?