Assessment Practices

1.Assessing the availability of and determining appropriate community resources

• Assess each resource for availability (waitlist, capacity), eligibility, cost, location and transport, hours, language, accessibility, cultural fit and quality before referring.
• Directories such as 211 (in most of the US and Canada) help locate services, but confirm current details directly; information changes quickly.
• A warm handoff (introducing the client, sharing information with consent, sometimes accompanying them) succeeds far more often than handing over a phone number.
• Respect client choice among options, and follow up to confirm the connection was made and the service fits.
• When needed resources do not exist or are inaccessible, document the gap and bring it to supervisors, coalitions or funders for advocacy.

In practice: A senior needs a food program but has no car. The worker checks which programs deliver, confirms eligibility and wait times by phone, makes the referral with the client’s consent, and calls back a week later to confirm the first delivery arrived.

2.Factors and processes used in goal planning, treatment planning, triage, and service plans

• Triage puts imminent danger first (suicide, violence, medical emergency, child at risk), then urgent basic needs (shelter, food, medication), then other goals; Maslow’s hierarchy is a common shorthand.
• Goals state the broad outcome the client wants; objectives are specific, measurable, achievable, relevant and time-limited (SMART) steps toward it.
• A service or treatment plan names the problem, goals, objectives, interventions, who does what, time frames and how progress will be measured.
• Plans are written with the client and other key people, in the client’s words where possible, and reviewed and revised as circumstances change.
• Level-of-care decisions use explicit criteria; in addiction care, the ASAM Criteria (4th edition, 2023) rate six dimensions (intoxication, withdrawal and addiction medications; biomedical conditions; psychiatric and cognitive conditions; substance use-related risks; recovery environment interactions; person-centered considerations) to match the least intensive safe and effective level of care.

In practice: A newly referred family has an eviction notice, a teen who self-harms and a parent wanting parenting help. The worker first assesses the teen’s suicide risk, then addresses the eviction, then schedules parenting work, explaining the order to the family.

3.Criteria used in the selection of intervention/treatment modalities (e.g., client/client system abilities, developmental level, culture, life stage)

• Modalities include individual, couple, family, group and community work; choose based on the problem, the evidence, the client’s preference and what is available.
• Match the approach to abilities and developmental level: play and art for young children, concrete and skill-based methods for people with cognitive limitations, adapted materials for low literacy.
• Consider culture and life stage: some clients prefer family-centered or faith-based help, others individual and private help; adolescents may engage better in groups of peers.
• Safety can rule a modality out: couple or family sessions are not used when there is ongoing intimate partner violence or coercive control; acute suicidality or active psychosis may make group work unsuitable until stabilized.
• Use the least restrictive, least intrusive level of care that is safe and effective, and step up or down as needs change.

In practice: A couple asks for counselling, and in separate screening the wife describes being choked last month. The worker does not begin couple therapy; she focuses on the wife’s safety planning and refers the husband to an abuse intervention program.

4.Cultural considerations in the creation of an intervention plan

• Ask how the client and family understand the problem and its causes (Kleinman’s explanatory model questions) and what help they consider appropriate.
• Define goals that are meaningful in the client’s culture; avoid imposing individualistic goals, such as independence from family, on clients whose values are more collective.
• Respect who participates in decisions (elders, extended family, community leaders) as the client wishes, and plan around religious practices, holidays and gender norms.
• Integrate traditional healing and community supports (for example, Elders, ceremonies, land-based programs, faith leaders) alongside formal services when the client wants them.
• Use culturally adapted evidence-based practices and services in the client’s language, and check that the plan is acceptable to the client rather than assuming it is.

In practice: A Cree youth leaving residential treatment wants to reconnect with his community. The aftercare plan includes regular time with an Elder and a land-based program alongside counselling, as he and his family requested.

5.Indicators of client/client system readiness for termination

• Indicators of readiness: goals met or substantially met, symptoms reduced on measures, the client handling problems independently, a support network in place, and the client raising the idea of ending.
• A plateau with no further benefit, or a service no longer matching needs, also indicates ending or referral.
• Common reactions as the end approaches include denial, regression (old symptoms returning), anger, or missing sessions; these are usually temporary and are explored, not automatically treated as proof that services must continue.
• Gradual steps such as spacing sessions further apart test readiness and build confidence.
• Plan termination from the start, review gains with the client, plan for setbacks and make sure the client knows how to return.

In practice: As the final session nears, a client who has done well reports her panic attacks are back. The worker explores her feelings about ending, reviews the skills she used, and agrees on one follow-up session a month later rather than restarting weekly therapy.

6.Use and side effects of common prescription, over-the-counter, and alternative medications

• Antidepressants: SSRIs (fluoxetine, sertraline, escitalopram) and SNRIs (venlafaxine, duloxetine) take about 4 to 6 weeks to work; side effects include nausea, sexual effects and activation. They carry a warning about increased suicidal thinking in people under 25, so watch closely early in treatment. Stopping abruptly can cause discontinuation symptoms.
• Serotonin syndrome (agitation, fever, sweating, tremor, rapid heart rate) can follow combining serotonergic drugs, including with St John’s wort or some pain medications; it is a medical emergency. MAOIs require a low-tyramine diet; tricyclics are dangerous in overdose; bupropion can lower the seizure threshold.
• Mood stabilizers: lithium has a narrow therapeutic range and needs blood levels; toxicity (vomiting, diarrhea, coarse tremor, confusion) is worsened by dehydration and some anti-inflammatories. Valproate can harm a fetus and the liver; lamotrigine can cause a serious rash.
• Antipsychotics: first-generation drugs (haloperidol) cause movement side effects and tardive dyskinesia; second-generation drugs (risperidone, olanzapine, quetiapine, aripiprazole) cause weight gain and metabolic problems; clozapine needs blood monitoring. Neuroleptic malignant syndrome (high fever, rigidity, confusion) is an emergency.
• Benzodiazepines (lorazepam, alprazolam) relieve anxiety quickly but cause dependence, falls and confusion in older adults and dangerous sedation with alcohol or opioids; buspirone is not habit-forming but takes weeks. ADHD stimulants reduce appetite and sleep and can be misused.
• Addiction medications: methadone, buprenorphine and naltrexone for opioid use disorder; naltrexone, acamprosate and disulfiram for alcohol; naloxone reverses opioid overdose. Over-the-counter antihistamines such as diphenhydramine can cause confusion in older adults.
• The social worker does not prescribe or advise changing doses; you educate, monitor adherence and side effects, report concerns to the prescriber, address barriers such as cost and stigma, and respect a capable client’s right to refuse.

In practice: A client on lithium has had a stomach virus for three days and now seems confused and shaky. The worker recognizes possible lithium toxicity and arranges same-day medical care, rather than waiting for the next psychiatry appointment.

Clinical items expect knowledge of drug classes, timelines and dangerous side effects; Bachelors items expect recognizing side effects and referring to the prescriber.