Assessment in social work: a guide for learning and teaching
Service users and carers: Service user and carer perspectives on assessment
The review of textbooks by Crisp and colleagues found no clear evidence of service users or carers contributing directly to the books. A small number of texts included direct feedback from service users and carers on the assessment experience. However, several books encouraged readers to try to understand the experience of being assessed. In the case of frameworks, only one, on integrated care of drugs users, described feedback from service users, who had been consulted in focus groups about the experience of being assessed (Crisp et al, 2005, p 51).
Two other sources provide graphic descriptions of service user perspectives. The first source is the values and expectations statement in the NOS (TOPSS UK Partnership, 2004, pp 2–4) and may be paraphrased as follows.
- Conduct active, searching, creative assessments.
- Review all options before deciding on a plan.
- Consider alternative options when services needed are not available.
- Involve others in the whole process.
- Be honest about options and limitations.
- Assess risk and support appropriate risk-taking.
- Lobby on others’ behalf.
- Challenge one’s own organisation on behalf of others.
- Challenge lack of access to services.
- Facilitate independent advocacy.
- Help others to represent themselves.
The second source of service users’ and carers’ views is provided by the research undertaken for SCIE on assessment by the Salford CSWR (Shardlow et al, 2005). A number of the views expressed were similar to the sentiments expressed in the NOS expectations statement. For instance, there was a desire for dependability, for strong advocacy on the service user’s behalf and to see the worker stand up to management. The service users and carers in the Salford CSWR research spoke of their experience of professional social work assessment. Some of the remarks underline the discussion of language in Section 20:
Respondents pointed to the need for clarity both about the social work role and also the meaning of ‘assessment’. The respondents expressed the view that those who used services were often not clear about the aims or nature of the assessment processes used within social work. For example, service users and carers felt there was a lack of understanding by professionals about the need for plain English and considered that professionals tended, albeit unconsciously, to use jargon. Similarly, the respondents commented upon the importance of trained, independent interpreters and the need for social workers to be educated in the use of interpreters and the inherent risks in using family members, particularly children, as interpreters when making an assessment.
Fear of social workers and anxiety about what they might do were very real issues for the respondent groups. The negative public image of the social work profession and experiences of past bad practice were seen as a barrier to the creation of trust. The need for social workers to provide re-assurance and to spend time trust-building, were considered to be paramount elements of good social work practice. This was a strong message that social workers needed more time to build relationships and understand the prevailing culture of the wider service user group. Indeed, respondents lamented the fact that they were often in a position of having to educate and train each new social worker about their culture, their condition, or about resources in the area. Respondents considered there to be a need for social workers to conduct preparatory research prior to the assessment visits. The African Caribbean Mental Health Service highlighted the fact that they were ‘not always ill’ and an holistic assessment should include getting to know them when well and when unaltered by medication. (Shardlow et al, 2005, pp 33–4)
In collaboration with the respondents, the research team compiled a list of key points for an ‘ideal’ assessment (Fig. 2).
Fig. 2 Suggestions made by members of users’ and carers’ groups about good practice in assessment (Shardlow et al, 2005, pp 35–6)
The right to a full assessment – there should be full and easy access to assessment for all groups
If you have English as a second or third language and your child is disabled, how do you know your entitlement? (Member of Blackburn Asian Blind Association)
The need for flexible services
In our culture, we do not really have appointments; we came from a place where you would just turn up if you wanted to see an official. (Member of Iranian Community Group)
Avoiding stigma of requesting help
People here are from a generation who would not ask for help … I said I would look after my wife through sickness and in health, I don’t see myself as a carer, I am a husband. (Member of Bolton Dementia Carers Support Group)
Social workers should be well prepared – by researching the general culture or condition of the group/community/individual prior to the assessment
They should tell you all the information you might find useful about rights, finances about social facilities and groups like ours. (Member of Manchester People First)
Social workers should be honest (and accurate) in their assessments
It was full of false praise like ‘she brushes her hair lovely, she dresses very well’ – it wasn’t realistic because some days I don’t bother getting dressed! (Member of African Caribbean Mental Health Group)
Social workers should speak to service users and carers independently
You can’t complain about being exhausted in front of them [the person you are caring for]. (member of Bolton Dementia carers support group)
The Social Worker didn’t even talk to me; she spoke to my mum and then went. (Member of Learning Disabled People’s Group)
Social workers should write records of assessments jointly with service users and carers
Social workers should make arrangements for trained interpreters and independent advocates to be part of the assessment process
Social workers should not have low expectations of people
I have a degree, but because I am visually impaired, they always want me to go for jobs in call centres – they need to show us opportunities to improve our lives. (Member of Asian Disability Group)
Questions for educators
- How do students learn of service users’ and carers’ perceptions, expectations and experiences of assessment?
- Do students have the opportunity to draw on their own experiences of being assessed in various contexts in order to reflect on possible user experiences and expectations?