Patient Assessment Paper

Introduction
This paper will show how assessment is a core part of the client’s treatment. It will show how assessment is done at the beginning of the treatment process but, will allow you to see that assessment is a continuing process. It results from a combination of focused interviews, testing, and record reviews. Assessments give the social worker a framework of reference to understand the strengths, weaknesses, problems, and needs of the client for the development of the treatment plan. It provides the social worker with a theory-based framework for generating hypotheses about the client’s experience and behaviors, which in turn helps prepare the basis for a specific treatment intervention. This paper will discuss the assessment tools

that match Cognitive behavioral Therapy and show how it leads to intervention.
Views of Assessment
In CBT, as with all other forms of treatment, the therapeutic process starts with an assessment. The unique contribution of the CBT assessment is what Vonk and Early call the cognitive analysis. Although the analysis can take many forms, it essentially identifies the problems, thoughts, feelings and actions that accompany those problems. Then a working hypothesis is developed to explain the relationship between the specific problem and the client’s unique responses. In REBT, the cognitive analysis uses the ABC technique. In this approach, the therapist looks for an ABC pattern where: A is the activating event (for example, a child is killed in a car accident), B is the belief (now that she’s dead everything will be awful) and C is the resultant emotional and behavioral consequences (such as sadness, fear and isolating behaviors). Notice how the belief comes in-between or mediates the relationship between the event and the feelings and behaviors. That’s because CBT assumes that events do not cause feelings and behaviors, rather our views of those events, or interpretations of those events, are what causes our feelings and behaviors. This assessment allows the therapist to identify consistent and predictable patterns of behavior that can then become the target of intervention.
Social workers that use functional analysis to examine what a client was doing and thinking as well as what was going on in the environment before, during, and after an episode of the symptom. This will help design successful interventions that are likely to help modify the problem behavior and thoughts.
Assessment Tools
At the agency that I work at we use several assessment tools to evaluation our clients.

Our main assessment tool is the Addiction Severity Index (ASI) it is a widely used structured interview that is designed to provide important information about what might contribute to a client’s alcohol or drug problem. The instrument assess seven dimensions that typically are of concern in addiction: (1) medical status, (2) education/employment status/support status, (3) drug/alcohol use, (4) legal status, (5) family history, (6) family/social relationships, and (7) psychiatric status. The ASI was the first standardized assessment tool of its kind to measure the multiple dimensions of substance abuse. The ASI is conducted in an interview format by clinicians worldwide. It has been used as an assessment tool by state agencies and treatment providers and has been translated into 18 languages (McLellan, Luborsky & Woody,

1980).
Our agency also utilizes several quick screen tests that all clients take; the first one is the CAGE questionnaire, the name is an acronym of its four questions, is a widely used screening test for problem drinking and potential alcohol problems. Two "yes" responses indicate that the possibility of alcoholism should be investigated further. The questionnaire asks the following questions: (1) Have you ever felt you needed to Cut down on your drinking? (2) Have people Annoyed you by criticizing your drinking? (3) Have you ever felt Guilty about drinking? (4) Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover (Ewing, 1984)? The CAGE questionnaire, among other methods, has been extensively validated for use in identifying alcoholism.
The next assessment we use is the Lie/Bet Questionnaire it is a two question screening tool for pathological gambling. The two questions were selected from the DSM-IV criteria for pathological gambling because they were identified as the best predictors of pathological gambling. The Lie/Bet Questionnaire is useful in determining if a longer screening tool or further assessment is appropriate. Lie/Bet Questionnaire: (1) Have you ever had to lie to people important to you about how much you gambled? (2) Have you ever felt the need to bet more and more money ( Johnson, E., 1988 finish )?
Another assessment that we use is the Mental Status Examination (MSE) which is an assessment of a client’s level of cognitive ability, appearance, emotional mood, and speech and thought patterns at the time of the evaluation. It is one part of a full neurological examination which includes the social worker’s observations about the client’s attitude and cooperativeness as well as the client’s answers to specific questions. The most commonly used test of cognitive functioning is the Folstein Mini-Mental Status Examination (MMSE), developed in 1975 (Proust, M., Lawrence, A. P., & Silvestro, N. 2013).
We also do another assessment that is required by Division of Substance Abuse and Mental Health which is the Trauma Symptom Checklist (TSC-40). The TSC-40 is a 40-item self-report measure of symptomatic distress in adults arising from childhood or adult traumatic experiences. It measures aspects of posttraumatic stress as well as other symptoms found in some traumatized individuals.
Clients are asked to rate how often they have experienced each symptom in the last two months using a 4-point frequency rating scale ranging from 0 ("never") to 3 ("often").

In addition to yielding a total score (ranging from 0 to 120), the TSC-40 has six subscales: Anxiety, Depression, Dissociation, Sexual Abuse Trauma Index, Sexual Problems, and Sleep Disturbances (Elliot, D & Briere, J., 1992).
Then we have the ASAM dimensions of care that we have to assess each client for placement. ASAM's criteria, formerly known as the ASAM patient placement criteria, is the result of a collaboration that began in the 1980s to define one national set of criteria for providing outcome oriented and results based care in the treatment of addiction. Today the criteria have become the most widely used and comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction and co-occurring conditions. ASAM's criteria are required in over 30 states.
The ASAM criterion is useful to patients, treatment providers, managed care providers, and other stakeholders and professionals. The criteria have become the most widely used and comprehensive set of guidelines for assessment, service planning, placement, continued stay and transfer/discharge of patients with addiction and co-occurring

conditions.
Patients are encouraged to work with their treatment providers to create an individualized treatment plan based on the ASAM criteria’s assessment dimensions. The criteria views patients in their entirety, rather than by a single medical or psychological condition. This means it pays attention to the whole patient, including all of his or her life areas, as well as all risks, needs, strengths and goals. For treatment providers, the ASAM criteria provides a holistic approach for determining individualized and outcome-driven treatment plans for patients (Mee-Lee, 2013).
The next assessment that we utilize is the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) is an update of a major diagnostic tool (APA, 2013). The manual was originally designed to help mental health professionals within a wide variety of disciplines assess and conceptualize cases in which people were suffering from mental distress. This conceptualization is important in that it facilitates an understanding in a common language toward the development of treatment planning to address complex and entrenched symptomology.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the United States. It is intended to be used in all clinical settings by clinicians of different theoretical orientations. It can be used by mental health and other health professionals, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors. DSM-5 can also be used for research in clinical and community populations. It is also a necessary tool for collecting and communicating accurate public-health statistics. DSM consists of three major components: the diagnostic classification, the diagnostic criteria sets, and the descriptive text.
The diagnostic classification is the official list of mental disorders recognized in DSM. Each diagnosis includes a diagnostic code, which is typically used by individual providers, institutions, and agencies for data collection and billing purposes. These diagnostic codes are derived from the coding system used by all U.S. health-care professionals, known as the International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM).
For each disorder included in DSM, a set of diagnostic criteria indicates symptoms that must be present and, for how long as well as a list of other symptoms, disorders, and conditions that must first be ruled out to qualify for a particular diagnosis. While these criteria help increase diagnostic reliability, it is important to remember that these criteria are meant to be used by trained professionals using clinical judgment; they are not meant to be used by the general public in a cookbook fashion.
The third area of DSM is the descriptive text that accompanies each disorder. The text of DSM-5 provides information about each disorder under the following headings: Diagnostic Features, Associated Features, Supporting Diagnosis, Subtypes and/or Specifiers, Prevalence, Development and Course, Risk and Prognostic Factors, Diagnostic Measures, Functional Consequences, Culture-Related Diagnostic Issues, Gender-Related Diagnostic Issues, Differential Diagnosis, and , Recording Procedures ( American Psychiatric Association, 2013).