2.4. Assessment of need for assistive devices
2.5. Interpreting assessment results to plan the support programme
2.1 Formal and informal assessments – medical, therapeutic, psychological assessments
Assessment is entering every phase of professional development. Assessment and evaluation are crucial steps in educational process. Before making a choice of assessment method, some important questions must be asked: what should be assessed?, why assess? For an assessment instrument one must also ask: is it valid? Is it reliable?, is it feasible? What is assessed and which methods are used will play a significant part in what is learnt. A wide range of assessment methods currently available include essay questions, patient management problems, modified essay questions (MEQs) checklists, OSCE, student projects, Constructed Response Questions (CRQs), MCQs, Critical reading papers, rating scales, extended matching items, tutor reports, portfolios, short case assessment and long case assessment, log book, trainer’s report, audit, simulated patient surgeries, video assessment, simulators, self assessment, peer assessment and standardized patients.
A Medical assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled nursing facility. Health assessment is the evaluation of the health status by performing a physical exam after taking a health history. It is done to detect diseases or disability early in people that may look and feel well
Mini-Clinical Evaluation Exercise (Mini-CEX) is a rating scale developed by American Board of Internal Medicine to assess six core competencies of residents: medical interviewing skills, physical examination skills, humanistic qualities/professionalism, clinical judgment, counseling skills, organization and efficiency.
Test of clinical competence, which allows decisions to be made about medical qualification and fitness to practice, must be designed with respect to key issues including blueprinting, validity, reliability, and standard setting, as well as clarity about their formative or summative function. MCQs, essays, and oral examinations could be used to test factual recall and applied knowledge, but more sophisticated methods are needed to assess clinical performance, including directly observed long and short cases, objective structure clinical examinations, and the use of standardized patients.
Therapeutic Assessment is a short-term intervention in which traditional psychological tests are used collaboratively with clients to help them understand themselves better and find solutions to their persistent problems.
In its underlying philosophy, Therapeutic Assessment is related to humanistic and human-science psychology, to narrative, interpersonal, and systemic models of psychotherapy, and to intersubjectivity theory. However, Therapeutic Assessment also uses techniques from many schools of psychotherapy, including cognitive therapy, behavior therapy, psychodynamic therapy, interpersonal therapy, and Gestalt therapy.
Therapeutic Assessment is a paradigm in which psychological testing is used to help people understand themselves better and find solutions to their persistent problems. Therapeutic Assessment differs from traditional psychological assessment, whose main goal is to diagnose disorders, plan treatments, and evaluate the effectiveness of interventions; Therapeutic Assessment can serve all these purposes as well, but its primary goal is to facilitate positive changes in clients.
Psychological assessment is a process of testing that uses a combination of techniques to help arrive at some hypotheses about a person and their behavior, personality and capabilities. Psychological assessment is also referred to as psychological testing, or performing a psychological battery on a person.
Psychological assessment may come in two forms: formal and informal. Formal assessment involves the use of tools such as tests, questionnaires, checklists and rating scales, while in informal assessment the interview/evaluation usually lacks such structure or organization. In either case, the psychologist will typically start by asking questions.
Formal assessment, often referred to as psychological evaluation, is generally performed by a licensed psychologist when a problem, that does not have a physical origin, is noticed and the cause needs to be determined. This problem can exist in several realms, for example: (1) inappropriate behavior (2) inappropriate mood states (3) failure to perform up to expected standards (as in schoolwork).
The purpose of evaluation is to determine what is happening in the individual's psychological life that may be blocking their ability to behave (or feel) in a more appropriate and constructive manner. Testing cannot necessarily pinpoint the precise cause of the disturbance, especially if it is a complex emotional issue, but it will give a number of clues that can help the individual, parent and/or professional go in the right direction. In some cases that are more specific, such as dyslexia or other learning disability, testing will let the parent and teacher know exactly what steps need to be taken to help the child/adolescent learn.
Generally, a full battery of psychological tests can take several hours to administer (often administered to a child in several one to two hour time periods to avoid fatigue). It takes several more hours for the professional to score and interpret the test results and to write a report suitable for school personnel or a psychotherapist to use in developing a curriculum or treatment plan. Occasionally, a psychologist will determine that only a few tests from the full battery need to be administered to pinpoint or rule out a particular problem and thus avoid an unnecessarily lengthy and expensive procedure. Whichever you and the professional determine is necessary, the results should yield a wealth of information useful to the individual, parents, educational institution or other professionals to make one’s emotional, educational and/or vocational life more healthy, satisfying and successful.
2.2 Assessment of family resources and family support system
Severe illness or disability can disrupt family life, cause family dysfunction, strain resources, and cause caregiver burden. The family's ability to cope with crises depends on their resources. Caregiver strain measures stress or burden due to the physical, personal, emotional and financial stress incurred by a caregiver as a result of, or in relation to, his/her caregiving role/s.
Family resources - means that can be used by the family to cope with difficult situations; include the following resources:
· social resources - strong social support network which may include spouse, children, parents, siblings, neighbors, co-workers and others
· cultural resources - cultural values which can influence an individual or family's ability to care for the sick and cope with stress e.g. optimism, familialism, approach vs avoidance style, etc.
· religious resources - spiritual beliefs, practices and support services
· economic resources - family's income and savings
· educational resources - level of formal education attained by an individual which allows him to understand the patient's condition and give him appropriate care
· medical resources - acessibility to medical facilities and adequacy of help from healthcare providers
Family Assessment Tools
There are many tools that can be used to conduct family assessment. Each collects specific information about family systems, functioning, culture, and experiences. Regardless of the tool selected, several key ideas to consider when selecting a tool for each specific family include:
· Timing (before or at the beginning of service delivery to design strategies, during intervention to assess effectiveness)
· Method (conversation, checklist, or questionnaire)
· Data collected (family interests, priorities, concerns, routines, traditions, resources and activities)
· Developmental framework (child development)
· Reporting method (method information is shared with family/practitioners to inform IEP/IFSP development and EBP)
· Requirements for early intervention or early childhood providers (active listening, feedback and sharing information)
· Comfortable for family (confidentiality of information and tone of the tool)
Through active listening, feedback, and sharing information, a family assessment is able to capture the life of a family in a way that feeds directly into service delivery. It should engage family members (not just parents) in conversations with each other or with the professional to consider the present, the future, successes, and challenges.
The benefits of Family Based Assessment include:
· It facilitates family participation
· It helps providers understand the family’s strengths, goals, and priorities
· It helps identify the family system and resources
· It helps to reflect the voices and choices of the family
· It reflects the families’ needs so that intervention can be tailored to address those needs
What is Family Support?
Families want the best for their children, to nurture their growth and development. Families with children who have special needs want the same for their children, but often face additional challenges, including great stress, social isolation, and financial strain. Families may become overwhelmed, and find it difficult navigating the service system for their child, and to find social and emotional support for themselves. "Family Support" helps families access a broad array of supports and services, including formal supports (such as paid respite care) and informal supports (such as parent-to-parent connections) and a community system of services that promote the well-being of families and their children with special needs.
Family support aims to:
- Increase the strength and resilience of families
- Support parents as they help their children with special needs achieve their full potential
- Improve community capacity to serve families with children who have special needs
- Helps families make critical connections to other families and resources in the community
- Provides individualized, family-driven support that respects family culture, values, and preferences
The Family Support Program works with families, communities, and
service providers to promote and provide support for families with children who
have special needs – which includes special health care needs, developmental
and learning disabilities, and behavioral/mental health diagnoses.
Family Support includes:
- Information about diagnoses, disabilities, and resources – how to find services
- Parent-to-parent support - connection to others who have had similar experiences
- Workshops and support groups – training and strategies you can use
- Social activities - fun and recreation for the whole family
- Family advocacy and policy development - involvement in shaping family and disability-related policies and services
How do Families and Children Benefit from Family Support?
Families find information and emotional support, and learn about enhancing their child’s development and well-being – all of which promotes improved outcomes for families and children.
Benefits
- Increases families' level of knowledge about their child's condition
- Increases families' feeling of competence in their caregiving
- Connects parents with similar experiences
- Fosters development of new social relationships
- Reduces the sense of isolation
- Provides opportunities for families to support others and to improve the service system
When do Families Seek Support?
Families with children ages birth to young adulthood seek family support for lots of reasons. Here are just some:
- Understanding a new diagnosis
- Infant born prematurely or in the NICU
- Transition to early intervention, preschool, public school, post-secondary education or employment
- Family moving to North Carolina
- Finding local services and service providers
- Advocating for educational rights and services
- Financial planning for families with children who have special needs
- Finding special services such as getting a ramp built or inclusive summer camps
- Parenting education and strategies
- Workplace support for employees with children who have special needs
- Dealing with stigma and bullying
- Balancing the needs of typically developing siblings
2.3 Assessment of current level of functioning – personal care, communication and social skills, mobility
Assessing levels of functioning
Functional assessments help identify the level of support, supervision and resources a person needs. They can be used to determine eligibility, care planning and assessing outcomes.
What functional assessment covers
Functional assessment practices consider differences in cognition, communication, sensory abilities (sight, hearing) and mobility.
Rather than simply asking people questions about their educational history or contact with disability-related support services, or whether they can perform a specific skill related to cognitive functioning, it's better to ask them to demonstrate a particular skill. In other words, you assess what a person 'does do', rather than what they 'can do'.
Functional assessment shifts the focus from the cause of disability or cognitive impairment to the impact of the condition. It's important to distinguish between capacity limitations that result directly from a person's health status and those limitations in which a person's participation is restricted due to environmental factors, including their physical environment and social.
The World Health Organization lists a number of activity and participation domains in its Checklist for International Classification of Functioning, Disability and Health (World Health Organization 2003) that should be considered in functional assessments.
Functional assessment domains
|
Domain |
Skills |
|
Learning and applying knowledge |
Watching |
|
Communication |
Receiving
and producing spoken message |
|
Domestic life and mobility |
Shopping |
|
Interpersonal interactions and relationships |
Forming
and maintaining intimate relationships |
