“Initial psychosocial assessment” means more in hospice talk then just assessing psychosocial functioning. In the hospice world it actually refers to the set of tasks that the social worker accomplishes when making her introduction to a patient and family. This first set of tasks includes relationship building and providing education about hospice, advance directives and end-of-life wishes.
The psychosocial assessment itself is a report of the psychosocial risks and strengths, and your analytical synthesis of both. Psychosocial risks include any factor in their lives or in the system surrounding their lives that is likely to cause emotional distress. Psychosocial strengths are factors that will likely promote emotional well-being. Your analytical synthesis puts all of these pieces of information together in order to describe how the patient and family are doing, and how they are likely to do has they approach the end of a life.
Structuring the assessment
The best assessments have the most narrative and the least amount of boxes to check. People’s lives, their strengths and the challenges they face are worthy of the rich human description that can be created using human thoughts, feelings and words. Very likely though, many hospices use assessment forms with more boxes and less encouragement to describe.
Michael Giles is a hospice social worker and psychotherapist who works in Austin and Cedar Park, Texas. Also by Michael: When political differences threaten relationships
Obviously you want to use whatever forms your company uses. But to get a sense of the psychological and social strengths and risks in a patient’s life and surrounding system, composes a statement or two about the risks and strengths of each of the following dimensions:
- Physical environment
- Care-providing system
- Physical functioning and how well adapted it is to environment
- Family and other relationships
- Cognitive functioning
- Emotional well-being of the patient and family members
- Pleasure activities
- Thoughts about receiving comfort care instead of continuing to try to cure an illness
- Spirituality
And then ask yourself, overall, how well are the patient and family members likely to manage? In which of these areas is there a risk that is not adequately mediated? For example, if the spouse is saying, “We’ve got next to know money,” is there a plan or resource in place already to ensure that care and basic needs will be funded? If not, there’s significant financial risk, and this is something to emphasize in your analytical evaluation.
Presenting your assessment
One way to present your assessment is to attach a description of the risks and strengths of each dimension next to each list item above, and follow that with a short paragraph that incorporates the most significant factors in the patient’s life. Another way is to write out a paragraph about strengths, a paragraph about risks, and finish with your analysis.
Because you are a social worker–or are on your way to become a social worker–you have at least a start to knowing how to approach these topics. It is good to relax. Don’t treat the questions as taboo, but use gentle and casual tact because they are not all comfortable topics. I usually ask, “Is there any concern about finances?” If they say “no,” I trust them without insisting on learning how much money they have. If they say “yes,” they are likely to follow with some details.
Next step: set goals and plan interventions
When we reconvene, we’ll discuss what to do next. Once we know the risks and the strengths and have given thought to how they will interplay, we give some thought to exactly what we plan to do to help. See you then!