« Previous | Contents | Next »
Listen
Effective Interventions Unit - Young people with, or at risk of developing, problematic substance misuse: A guide to assessment
Chapter 6: Assessment Tools
There is a lot of interest among agencies and service providers in the use of assessment tools. Tools can aid the assessment process. However, they are
not a substitute for engaging in dialogue, or a substitute for a skilled and experienced worker who can relate to young people. Where a tool is used, it should be done sensitively. Even the best assessment tool could be damaging to clients in the wrong hands or in the wrong context ('Identifying Learning and Support Needs: a digest of assessment tools' SE 2001).
"I think it is better talking to people other than doing tick boxes because tick boxes make me feel like a bit of a robot. I think it is better talking to counsellors because instead of giving a one answer to questions you can express your feelings."
-
Quote from a 15 year old girl |
What are assessment tools ?
"Assessment tools are
instruments developed by practitioners or academic institutions
that facilitate the collection of information in a systematic fashion. Tools are used in a range of sectors to
assist the assessment process. They can help to guide and structure dialogue between worker and client. Outcomes of assessment can be measured, contrasted and compared in order to assist the practitioner and the client in identifying the nature and extent of problems and measure the 'distance travelled' " (EIU 2002, 2003 amended).
One of the findings from our consultations is that, in some cases, tools may be used for assessment although that is not their purpose. We asked practitioners for examples of tools that they had used and their experience of using them. The responses indicated that there was some uncertainty about what constituted an assessment tool: for example, data collection/monitoring forms were suggested as assessment tools. This seemed to reflect the findings from a survey of assessment tools in use in agencies (Rome A, 2002) which showed that, for example, the SMR24 (Scottish Drug Misuse Database) monitoring form was one of the most frequently mentioned tools, although it is not designed to be used as an 'assessment tool'.
Some assessment tools are designed for self-completion and involve minimum input by the worker. These can be done quickly and easily, for example using tick boxes, or scores/ratings (smile - sad faces might be one way of representing this). Also, some of these tools are computer-based.
During consultation with practitioners on the use of assessment tools, there was feedback on the merits of self-completion tools. For some young people this is a popular option because it is seen as an enjoyable task and retains their ownership of the assessment. Computer-based tools were recognised as appealing to young people, helping them to formulate their thoughts and feel more confident in later discussion with workers. However,
self-completion tools may not be suitable for young people who have literacy problems or for those with complex issues. The assessment tools discussed below include tools designed for self-completion (or with a self-completion component).
Practitioner views on assessment tools
The EIU's consultation seminars examined some of the assessment tools currently in use, and sought people's views on them. This exercise identified
a number of tools in use across agencies, some recognised and validated for use with clients who have particular issues. There were agencies who had created their own tools or adapted existing tools to meet local needs. However,
not everyone used tools or felt the need to use them.
We also asked whether practitioners were looking for a standard assessment tool for use with young people. The general consensus was that it would not be feasible to develop a single national tool that would be flexible enough to meet all local needs. Practitioners felt there should be a
range of tools available, a
'tool box' or
'tool shed', from which they could select those that best met their needs. Practitioners also recognised the potential merit in implementing
common guidelines for assessment, or an assessment framework, across agencies working with children and young people. During our consultations for this guide we spoke with individuals involved in developing integrated assessment frameworks for children and young people in Aberdeen, Ayrshire, Fife and Glasgow. Also, since we undertook our consultations, work has been progressing on the development of a national integrated framework for assessment for children and young people. This initiative is described in more detail in
Chapter 7. Phase two of this project will incorporate a study of assessment tools in use across Scotland.
More in-depth discussion on particular tools in use (or tools tried in the past) identified some of the
advantages and disadvantages of using assessment tools:
Advantages: | Disadvantages: |
Standardised recording. Shared understanding among workers. Assists
information sharing. 'Tried and tested'. Tools provide a
checklist of issues to address. They allow you to measure, e.g. measure risk. They can corroborate what the worker is doing/act
as a 'cross-check'. Self-completion tools promote client participation and
allow the young person to be 'in control'. Help to get the young person
talking. Help to measure progress made. Can provide evidence to funders on outcomes. On the one hand this is a positive, but on the other there is the danger of this being the main driver, rather than focussing on the young person (see disadvantages). There are tools that provide the young person, and worker, with a
quick visual picture of where they are at (and progress made). Tools can
assist care planning for the young person. You can use 2 or 3
different tools together to meet a range of assessment needs. Tools can be adapted for local use.
| Tools attempt to standardise things, but different workers will still have different judgements. There is an
element of subjectivity, e.g. in scoring. Tools
can be lengthy and complex to administer, particularly if designed to meet a range of needs. Training needs, including ongoing training. Costs associated with use of some tools. Possible difficulties with
wording, e.g. medical sounding or associated with translation into English (EuroADAD from Dutch). Certain tools are
not appropriate for use with young people. Existing tools may need to be
adapted to meet local needs. There is a
lack of tools in the alcohol field. Many agencies use a
package of tools, as one tool is unable to meet all needs. Lack of flexibility (e.g. rigid tools are unlikely to cope with the transitional issues between young people and adult services). Can result in a loss of individuality for the worker and restrict the use of their skills. The formality of the tool
can inhibit relationship building between worker and young person. Tick boxes prevent self expression. Most tools are based on
reading and writing which can cause
problems for some clients (and workers) who may not have good literacy skills. Particularly for the voluntary sector, there is a
danger of focussing on using tools to generate statistics.
|
Examples of the use of tools
From our evidence gathering, we have identified a number of examples of the use of assessment tools by agencies. These examples cover a variety of topic areas and approaches.
This is not a comprehensive list of tools available and does not constitute a recommendation for these tools
1. The Problem Oriented Screening Instrument for Teenagers (POSIT)
POSIT is a validated 139-item, self-report
screening tool, using a yes/no response format, designed for adolescents. The POSIT screens for potential problems, and service needs, in
ten functional areas (i.e. drug use/abuse; mental health; physical health; family relations; peer relations; social skills; educational status; vocational status; leisure/recreation; aggressive behaviour/delinquency). It serves as a first step in identifying potential areas for more in-depth assessment.
The
Reiver Project, in the Borders, uses POSIT. Their involvement with their clients tends to be short-term and may involve a one-off contact, perhaps for an hour or two, in which they will have the chance for educational input. They find that POSIT offers
"a good checklist" of issues, although one potential drawback is that it is
"extremely long". It is also "quite American" in its terminology. They have, therefore, adapted some of the wording. There are some potentially sensitive questions, for example around sexual health, which may be difficult to address at an early stage of working with a young person, but at the same time may be important to ask. For further information on the POSIT see:
http://www.niaaa.nih.gov/publications/posit.htm
2. Step it Up self-assessment
The
Step it Up self-assessment website "has been designed to take young people on their own personal journey along the social and emotional development path". It suggests a
set of ideas and processes for youth workers to use to:
encourage reflective discussion with young people
help them support young people to chart their own progress in social and emotional competences
help them offer young people constructive support and encouragement.
There are
6 mini questionnaires (for the young person to complete on their own, or with a youth worker). The materials can be used either as part of an ongoing programme, or as a single assessment of competencies (and can be repeated every 3, 6 or more months).
The relationship and discussions between the worker and young person are the most important part of the process, based on effective youth work principles. This is a reflective, discussion-based approach which it is hoped will generate improved levels of social and emotional competence for the young people involved -"the website and materials are simply a tool for workers to use" .
Step it Up takes the young person and the youth worker through 4 key steps:
1.
Profiling (where am I?).
2.
Plan it (where do I want to go & how do I get there?).
3.
Do it (putting it into practice).
4.
Review it (what have I achieved? How do I know?)
The Step it Up self-assessment website is at
www.youngscot.org/stepitup
3. The Rickter scale
The Rickter scale is another example of a self-completion tool. The EIU Digest of Assessment Tools describes it as
"a non-paper based tool (a colourful plastic board) that allows clients to explore their circumstances, identify priority areas for support and interventions……." The structure enables clients to explore possibilities, set goals and contribute to their own action plans. Evaluation of the Rickter scale suggests that it positively encourages interaction between the client and the worker"….. "A bank of questions is available including personal social development, key skills, drugs and alcohol issues, preparation for work and community safety".
The EIU consultations on the use of assessment tools with young people identified advantages of the Rickter scale: the self-completion aspect which allows the young person 'to be in control'; the fact that it records the young person's views and opinions; and its ability to be used with a wide range of clients. One of the potential drawbacks that people highlighted was that how the young person chose to score the various questions would "depend on how the young person felt on the day".
The Rickter scale has also been used by the New Futures Fund projects, and evaluated.
Further information on the Rickter scale is available at
http://www.rickterscale.com/0101.htm
4. ASSET
ASSET is a tool developed for use with
young people involved in offending. It was initially used with Youth Offending Teams (YOTs) in England and Wales, then permission was extended for use in Scotland.
ASSET identifies the factors most closely linked with offending by young people. It also measures change and risk of re-offending over time, assists practitioners plan interventions and provides triggers to indicate need for further assessment.
The information collected covers a number of areas including: offending behaviour, education/employment, emotional/mental health, substance use, attitudes to offending, motivation to change and 'positive factors'. It also
includes a self-assessment questionnaire, indicators of vulnerability and indicators of serious harm to others.
A project using ASSET is the CHOICE project, Dundee. ASSET provides them with a structure for recording and analysing information, but it does not prescribe the way in which interviews should be conducted. Neither does it take away the need for skills of
engaging with young people and families -
establishing relationships with them remains central to the assessment.
ASSET is now used widely in Scotland and regular meetings take place of those local authorities using the tool.
Contact:
chris.wright@dundeecity.gov.uk
5. EUROADAD
The
EuroADAD has been adopted by Tayside services working with young substance users. The commonality of information collection helps them to plan services together.
The EuroADAD is a European version of the ADolescent Assessment Dialogue (formerly the Adolescent Drug Abuse Diagnosis).
There are 120 items covering 7 main problem areas: medical, school, social relationships, family relationships, psychological, criminal and alcohol/drug use. It also includes interviewer and client reporting ratings of need for help. The tool is designed to be completed in one session, to ensure consistency.
The target group is young people aged 12-24.
One of the services using the EuroADAD is Tayside Council on Alcohol who are involved in intensive long-term work with a small group of young people with substance misuse and wider needs. For them the tool produces a comprehensive baseline of where the young person is at (although the absence of a 'risk' section was felt to be a gap). As noted above, the tool has a feedback component: a summary of positives and negatives from each section, taking into account the young person's views on how big a problem they think particular areas are.
Young people's feedback on the tool has been very positive - "they've felt it's been their assessment too". Tayside services are also keen to explore the development of an interactive self-completion tool (between initial/screening and full assessment) and are looking to the EuroADAD to provide a framework for this.
Services in Tayside report some language difficulties associated with translation of the tool from Dutch. They have also identified areas to develop further such as housing and education, for example to cover young people who are absent or excluded from school or in off-site learning. Another potential limitation with this tool is that it requires 2 days of training and there are, at present, only 2 EuroADAD trainers in Scotland.
Further information on the EuroADAD is available at
www.euroadad.com or contact
Kathryn@alcoholtayside.com
6. Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA)
HoNOSCA is a tool that was developed to measure health and social functioning amongst those with mental health problems. Specifically,
HoNOSCA assesses the behaviours, impairments, symptoms, and social functioning of children and adolescents with mental health problems. HoNOSCA therefore provides a global measure of an individual's
current mental health status. It also provides a means of evaluating the success of any interventions to improve the health and social functioning of children and young people with mental health problems.
A project using the tool is the Child and Adolescent Substance Misuse Service (CASMS) in Dumfries and Galloway. This innovative project is part of the Child and Adolescent Mental Health Service.
For further information see
http://www.liv.ac.uk/honosca/
Other Resources
Resources that might be useful to practitioners working with young people include:
The EIU's 'Digest of Assessment Tools' (EIU 2003). It focuses on assessment for adult drug users but includes several tools that are suitable for use with young people. It can be downloaded at:
http://www.scotland.gov.uk/library5/health/dtap-02.asp
'Identifying Learning and Support Needs: a digest of assessment tools' (SE 2001). This digest was produced to support the assessment of young people who need support to make the transition from school to post-school education and training because of social, emotional and other problems. The tools in this digest are in the main intended to be for initial or first level diagnosis of need. Practitioners are encouraged to seek specialist assessment where individual clients need this. The digest is available at
http://www.scotland.gov.uk/library3/education/ilsn-00.asp
A recent 'Review of Assessment Tools to Support Guidance and Placing Activities', undertaken by Dr Marion Fisher, for Careers Scotland, May 2003. This is available at
http://www.careers-scotland.org.uk/careersscotland/web/site/LearningandGuidance/Research/ResearchIntro.asp
Glasgow City Council, in partnership with NHS Greater Glasgow, commissioned Human Factors Analysts to conduct an extensive global literature review on effective treatment and care for young drug and alcohol users. The resultant publication provides some details of assessment tools currently used in the UK and Europe. Contact
gemma.mcneill@sw.glasgow.gov.uk
For those who are keen to explore the use of assessment tools further, below is a checklist of issues to consider when selecting an assessment tool. This has been adapted from the checklist provided in the EIU's 'Digest of Assessment Tools' to incorporate the views of practitioners working with children and young people.
CHECKLIST Issues to consider when selecting an assessment tool: Who are you going to be assessing?
Select a tool that has been validated for use with your client group. We have already stated, for example, that many tools are not suitable for use with young people. What aspects of the young person do you want to assess? Does the tool cover these in sufficient detail? Think about how long you are likely to be working with the young person and how much detail is appropriate. For example, some services provide long-term treatment, care and support for young people while others offer a drop-in and referral-on, or short-term, intervention. Is the assessment approach suited to the needs of your client group? You may wish, for instance, to use a self-completion tool (see case studies on the Rickter scale and Step it Up self-assessment). How long does the tool take to complete? Some tools are designed to be completed in one or two sessions, while others are completed over a longer period of time. Consideration should also be given to the time required for scoring, if this is appropriate. Be aware that the time-frame covered by different tools can vary. Also,
how often is the tool designed to be completed ? (e.g. one-off completion to produce a 'baseline', or can be updated/repeated every 6 months allowing you to monitor outcomes or change). Consider the need for
staff training in use of the tool, along with the
skills and experience of those who will be undertaking the assessments. Administration: Tools that involve scoring and/or input of data to computer will put additional administrative pressure on frontline workers, and may require dedicated administrative support. Do you have to pay for copies of the tool or is it available free of charge, for example on the web. Consider
any limitations of equipment or premises (e.g. IT requirements). Before looking to develop a new tool,
be sure that there is not an existing tool (or package of tools) that could meet your needs with no, or only minor modification.
|
« Previous | Contents | Next »