This concludes a five-page outline of key assessment-options for the six
types of low-nurturance clients covered by this clinical model.
3, Part 2) - ASSESS SUBSYSTEMS AFFECTING the
CLIENT FAMILY
Typical low-nurturance family systems are in/directly affected by several
lay and professional sub-systems, like schools, social-service and medical
organizations, the regional family-law system, religious communities,
support groups, and mental-health persons and organizations. Each of these
subsystems ranges from (a) low to high nurturance, and (b) nurturing to
stressful with the client-family system.
For example, a local school can stress a client family by confronting the
adults with requests or de-mands that they "fix" a child who is
underachieving and/or acting out. An alternative view is that the school is
helping family adults by alerting them to a significant parental
problem, and inviting them to join them in helping the child. Glass
half-full, or half empty?
Because typical low-nurturance families are complex multi-problem systems,
identifying and asses-sing the systemic impact of related social subsystems
can require excessive time and energy from re-sponsible clinicians.
Implication - Assessing this half of a client's metasystem requires
wide-angle aware-ness, clear clinical focus and plans, balance, and triaging
available time, energy, and focus.
Basic subsystem variables to assess
are...
What are the lay and
professional systems currently affecting this client family?
Who initiated each
one's involvement, when, and why?
What is the apparent
nurturance-level of each of these programs or organizations now? See
this,
this, and
this as practical resources
for this assessment; and...
What's the recent
impact of this subsystem recently on the client-family system's
nurturance level - e.g. mostly nurturing (helping adults and kids fill
current primary needs, to mixed impacts, to mostly stressful (amplifying
present needs and adding new ones)?
And for each stressful subsystem...
What options do the
clinician and his or her agency and/or program have to improve any
significantly-stressful subsystem's impact on the client's family? Stay
aware of the relevance of the
in deciding this. Finally...
Are there lay and/or
professional family-support resources
like churches, hospital outpatient programs, support, self-help, and
chat groups, Web sites, and state and federal social-service programs,
that could significantly help the client family that client adults
aren't aware of or aren't using now?
5) Assess the ongoing clinical
for (a) blocks and (b) how client
adults are reacting to strategic interventions over time
- i.e. do
the adults' ruling subselves...
-
allow
second-order (core attitude)
systemic changes,
or...
-
make only first-order (temporary, cosmetic) changes, or...
-
resist any
significant systemic changes to their boundaries, roles, rules, goals, values, and
memberships?
Premise: two or more people or personality subselves who communicate over
time evolve identifiable
that help or hinder filling their
Clinicians need to assess these
sequences as the work proceeds, and intervene
strategically to reduce or remove significant process-blocks.
Chronic
(process) blocks usually indicate wounds + unawareness + ignorance in the
clinician, any supervisor or case manager, and one or more participating client
adults.
Status check:
How do you feel about
this premise about what to assess clinically with average
low-nurturance family clients?
_ I agree totally, and want to weave
these premises into my work;
_ I agree with some of these five factors, and
will experiment with some or all of them to see what happens;
_ I have a different idea of how to assess
low-nurturance families, which works well enough for me now.
When to Assess
these Factors
Effective clinicians will continually assess themselves and any professional
co-workers for
for work with these complex families, and acquire any that are missing. A
primary responsibility of supervisors and case managers is to honestly
assess (a) themselves and (b) each clinician they work with for these
requisites, and to take appropriate action.
Clinicians will assess many things about each client family system over
time, beginning with the first contact.
This assessment is evolving,
organic process,
because...
the client-family's members,
roles, rules, (some) values, boundaries, goals and environment
constantly change as the family system
evolves; and...
the elements of the clinical
metasystem dynamically change and interact with each other and their
common environment over time, shifting their members' beliefs,
behaviors, roles, boundaries, and priorities; and...
each client contact reveals more
information about the family system's history, rules, roles, and
dynamics, and how the participating family members are reacting to
recent clinical interventions.
Is There a Best Way to Assess These Complex Clients?
After
36 years'
clinical experience with members of hundreds of low-nurturance divorcing families and stepfamilies, my
bias is "yes." Two main
ways to assess a client family system over time are by observing (a) their
spontaneous behaviors (and lack of them), and (b) their reactions to
strategic interventions, like questions, suggestions, role plays,
confrontations, strategic omissions and silences, practices, and homework.
Assessment questions can be verbal or written, as in an intake questionnaire and
topical worksheets. Some cases will also include assessment information from other
human-service providers working with the client family members - e.g. teachers,
doctors, mediators, attorneys, clergy, social and welfare workers, law-enforcement professionals,
etc.
| Each
clinician, supervisor, and case manager evolves a preferred way to assess
new and existing clients. The "best way" is to (a) clearly define
and then (b) use whatever mix of assessment techniques yields enough
systemic information to allow effective interventions with this client
family. Effective interventions promote systemic changes that
clients and professionals agree are beneficial (fill
client-family needs) short and long term |
Assessment Resources in This Site
-
A summary checklist of assessment factors for all six client-types
-
Sample intake forms for
divorcing-family and
stepfamily clients
-
An index
of all clinical articles in this non-profit site, and...
-
This
collection of assessment worksheets and checklists
for clients
and clinicians.
-
This extensive
array of articles about common
family-system "problems" (stressors), and options for avoiding and
reducing them based on applying these
foundation-concepts and the 12
Projects.
-
These lay,
communication, and
professional glossaries to promote
and productive discussions, and thereby minimize misunderstandings,
confusions, and frustrations during the work.
Recap
This five-page article offers a framework of experience-based
suggestions about effective clinical asse3ssment of low-nurturance families
and individual trauma-recoverers, using this model. The domains are based on defining "effective assessment" as "a
clinician-unique mix of beliefs,
attitudes, and techniques that yields enough
information to design effective interventions that fit each unique
client." Comprehensive ssessment extends beyond learning the
client's presenting (surface) problems, including these domains:
-
the clinician (assess for personal and
systemic
and...
-
who
comprises the client's nuclear and extended-family systems, and...
-
the
clinical metasystem - e.g.
(a) the client family system + (b) each lay and professional
subsystem recently influencing the client-family's stability, nurturance
level ("functionality"), and wholistic health; and assess...
-
clinical-process
and
blocks; and...
-
how the client-system reacts to strategic
clinical interventions, over time: open to constructive
> mixed > closed to constructive change.
These domains apply to all client family systems. Each
of the
in this model has unique things to assess.
This article overviews variables that every clinician (including
supervisors, consultants, and case managers) will blend to form their unique
preferred method of client evaluation. From clinical experience since 1981, I
propose the best assessment choices in each variable for effective long-term clinical
outcomes with typical divorcing-family and stepfamily clients.
Pause and reflect - did you get what you needed from reading this
article? If so, what do you want to do now with these ideas and
resources? If not, what do you need now?
The Web address of this
five-page article is
https://sfhelp.org/pro/dx/basics.htm