views from above


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…

tardis60 said:

I’m glad that someone in social work not only had this concern but took the time and effort to ask, and ask realsocialskills in particular. This answer articulates for me so much about what I and family members have run into in these situations and explores many issues I identify with. And also made me think about all the reasons why these questions might be asked, all the reasons why reactions can be so uncomfortable, and what it’s like for the asker.

realsocialskills said:

Social work is really, really hard to do well. There’s so much going on in the field that puts pressure on social workers to treat people poorly and take them over.

And assessments are often part of that. They contain a lot of questions that are cognitive cues for views-from-above thinking, and the ways social workers are expected to phrase reports contribute to that even more. (And that kind of thing is really the tip of the iceberg.)

But social workers also sometimes do really important work, and a lot of it is work no one else is doing (the same is true of therapists, which is a similarly problematic field). So I don’t mean this as a general condemnation of social workers - social work is important, and important to get right. (There are social work roles that are wholly bad. But not all social work roles are like that). It’s hard to be in that field without adopting some really dangerous kinds of thinking.

I wish I knew more about how to do it well. I’m trying to find out as much as I can. Because I really, really want to support people who are trying to be good social workers.

Example of assuming we're not listening: TalkingTiles

There is an AAC app called TalkingTiles, that uses an interesting approach to managing communication pages. It offers cloud-based subscriptions and a library of available tiles, and can sync across multiple devices. It’s also possible to edit communication pages on a computer rather than on the iPad or whatever other mobile device it’s running on.

That’s good. What’s bad, is that they think of the users of this app as parents and therapists working with people who need communication software. They don’t seem to consider the people who actually use the app for expressive communication to be users; the app is something that is used on them rather than by them.

They describe it thusly:

TalkingTILES has helped those inflicted with a communication disability brought on by a neurological disorder (such as Autism, Cerebral Palsey, ALS or Parkinson’s) as with those who have suffered a trauma (such stroke or brain injury). We’ve taken a collaborative approach to AAC bringing together professionals (therapists, educators and support workers) and their clients,caregivers and families, enabling remote programming and remote content sharing across each other’s devices making AAC therapy more productive and efficient for both client and professional. 

Do you see what’s missing here? The end user, the person who will actually be using the device to communicate, is not addressed directly.
And it’s much more explicit in the user accounts. You have to have a cloud-based subscription to make the software do much, and there are two kinds of accounts:
TalkingTILES for Professionals & Caregivers :
• Professional AAC Support Teams - therapists, educators & support workers- your Mozzaz Cloud Subscription is FREE. We want you to learn, try and trust TalkingTILES as an effective AAC solution for your clients.
• Caregivers & Families - we understand the challenges and commitments that come with supporting and helping your loved one with a communication disorder. TalkingTILES offers the most flexible and adaptable AAC app that can be tailored to your personal needs at a very affordable price. We make AAC therapy productive and efficient through our collaborative model with professionals on your team. A Mozzaz Cloud Subscription plan will save you time, money and be more efficient with your AAC goals and programming.
There isn’t an option to register an account for yourself, as the person who will actually be using the app to communicate. There should be. People who use software to communicate have agency, and sometimes look for software options for themselves. Product descriptions, marketing, and design ought to take this into account.
When you’re designing adaptive equipment or software for people with disabilities, please remember that people with disabilities use it, and address them when you describe your product.