social work essay on assessment

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Writing analytical assessments in social work (3rd edition), chris dyke.

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Campbell Killick, Writing Analytical Assessments in Social Work (3rd Edition), Chris Dyke, The British Journal of Social Work , 2023;, bcad228, https://doi.org/10.1093/bjsw/bcad228

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Gaining a clear understanding of social situations through assessment is a core function of social work. In their analysis, the practitioner makes sense of the situation so that decisions can be made in an informed manner. Practitioners appear to be effective at engaging key stakeholders and gathering information, but interpretating the information can be difficult. This is as true today as it was in 2016 when Chris Dyke wrote the first edition of ‘Writing Analytical Assessments in Social Work’. This has become one of the key texts for practitioners and students who appreciate the accessible writing style and the use of practice examples. The book includes a valuable overview of the assessment process with practical guidance on the use of chronologies eco-maps and genograms to structure information. The third edition builds upon the strengths of its predecessors, updating the material and adding two important additional chapters.

Material on analytical writing (Chapter 4) has been supplemented with an entirely new chapter on analytical thinking (Chapter 5). This explores the unconscious processes that social workers use within their assessment and decision making. Whilst intuitive shortcuts seem to be a part of social work decision making, there is a danger that bias can distort the way in which data are filtered and evaluated ( Spratt, 2023 ). This could result in inaccurate understanding and discriminatory actions. Dyke outlines a range of such thinking processes and then applies this to the social work setting. He encourages practitioners to critically reflect on all sources of information including our own practice wisdom.

In his central chapter on analysis, Dyke presents a model to ensure that assessments move beyond description to an analytical understanding of the situation. The gathering of information (what happened) can be explored in the context of causation (why did it happen) and implication (what does this mean). These latter stages involve a subjective interpretation of the facts and as such there is a danger that prejudicial attitudes could distort our understanding ( Tedam, 2020 ). The book offers suggestions to support anti-oppressive assessment practice.

The second additional chapter uses the example of domestic violence to illustrate the concept of analytical thinking and writing. Dyke presents a theoretical framework that can be critically applied to support our understanding of the range of behaviours and the possible causes. When applied to this practice example, we realise that the ‘ why ’ question is challenging and needs to recognise the diversity of experience encompassed within the term. Any assessment of family violence needs to incorporate the implications for perpetrators, victims and service provision. The process of decision making and service planning is explored in a separate chapter. In the appendices of the book, there are practical guides to writing for child-care proceedings and best interest assessments.

Our struggles with analytical writing relate to organisational culture as much as individual skill and the final appendix outlines the role that teamwork and supervision play in the analytical thinking and writing process.

This third edition represents a useful development of an important text.

Spratt T. ( 2023 ) ‘Confirmation bias in social work’, in Taylor B.J. , Fluke J.D. , Graham J.C. , Keddell E. , Killick C. , Shlonsky A. , Whittaker A. (eds), The SAGE Handbook of Decision +-Making, Assessment and Risk in Social Work , Chapter 1, pp. 15 – 22 , London , Sage .

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Tedam P. ( 2020 ) Anti-Oppressive Social Work Practice . Exeter, Sage .

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Social Work Toolbox: 37 Questions, Assessments, & Resources

This may be because of its unlikely position, balanced between “the individual and society, the powerful and the excluded” (Davies, 2013, p. 3).

Social work is a unique profession because of its breadth and depth of engagement and the many governmental and private organizations with which it engages.

Not only does it help individuals and groups solve problems in psychosocial functioning, but it also attempts to support them in their life-enhancing goals and ultimately create a just society (Suppes & Wells, 2017).

This article provides a toolbox for social workers, with a selection of assessments and resources to support them in their role and career.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

6 best resources for social workers, top 17 questions to ask your clients, 2 assessments for your sessions, social work & domestic violence: 5 helpful resources, our 3 favorite podcasts on the topic, resources from positivepsychology.com, a take-home message.

Demanding professions require dedicated and supportive resources that transform social work theory into practice. The following worksheets and tools target some of the most challenging and essential areas of social work (Rogers, Whitaker, Edmondson, & Peach, 2020; Davies, 2013):

Emotional intelligence

“Understanding emotion arises from the combined consciousness of how we perceive emotions and use our intellect to make sense of them” (Rogers et al., 2020, p. 47).

For social workers, emotional intelligence is invaluable. They must develop and maintain awareness of both their own and their client’s feelings and use the insights to select appropriate interventions and communication strategies without becoming overwhelmed.

The Reflecting on Emotions in Social Work worksheet encourages social workers to stop and consider their feelings following an initial client visit.

In the worksheet, the social worker is guided to find some quiet time and space to reflect on:

• How do I feel about my initial visit?
• What are my thoughts regarding the purpose of the visit?
• How do I think I can proceed with developing a relationship with the client?
• How do I think the client feels about my visit?

Being self-aware is a crucial aspect of social work and will inform the ongoing relationship with the client.

Fostering empathy

Mirror neurons fire when we watch others performing an action or experiencing an emotion. They play a significant role in learning new skills and developing empathy for others’ experiences (Thomson, 2010).

Social workers must become more aware of service users’ experiences, as they can influence and affect the interaction with them.

Use the Fostering Empathy Reflectively worksheet to improve the understanding of your own and others’ emotions and increase the degree of empathy.

Observing others can make social workers more aware of human behavior and the emotions and thoughts underneath to increase their capacity for empathy.

Reflective cycle

Reflecting on situations encountered on the job can help social workers fully consider their own and their clients’ thoughts and feelings before drawing conclusions. Indeed, “successful reflection emphasizes the centrality of self-awareness and the capacity for analysis” (Rogers et al., 2020, p. 64).

Use the Reflective Cycle for Social Work to reflect on events, incidents, and behaviors in a structured and systematic way (modified from Gibbs, 1988).

Challenging social interactions

Good communication skills and confidence in social interactions are essential for social work. There will be times when you need assertiveness to challenge others to ensure the client’s needs are met (Rogers et al., 2020).

However, like all skills, social skills can be learned and maintained through education and practice.

The Preparing for Difficult Social Interactions worksheet considers how a situation or event may unfold through focusing on the essential issues.

Practice and role-play can help social workers prepare for a more successful social interaction and gain confidence in their coping abilities.

Motivational Interviewing in Social Work

“Change can become difficult for service users when they are ambivalent about the extent to which the change will be beneficial” (Davies, 2013, p. 451).

One method used by social workers to explore their clients’ intrinsic values and ambivalence is through motivational interviewing (MI). MI has four basic principles (modified from Davies, 2013):

• Expressing empathy Displaying a clear and genuine interest in the client’s needs, feelings, and perspective.
• Developing discrepancy Watching and listening for discrepancies between a client’s present behavior and values and future goals.
• Rolling with resistance Avoiding getting into arguments or pushing for change.
• Supporting self-efficacy Believing in the client’s capacity to change.

The Motivational Interviewing in Social Work worksheet uses the five stages of change to consider the client’s readiness for change and as input for selecting an appropriate intervention (Prochaska & DiClemente, 1986; Davies, 2013).

The client should be encouraged to create and implement a plan, including goals and details of the specific tasks required.

Respectful practices

Rogers et al. (2020) identified several fundamental values that social workers should be aware of and practice with their service users, families, and other organizations with which they engage. These include:

• Individuality
• Honesty and integrity

The Respectful Practices in Social Work worksheet encourages reflection on whether a social worker remains in touch with their values and the principles expected in their work.

Social workers should frequently think of recent examples of interactions with clients, families, and other organizations, and ask themselves (modified from Rogers et al., 2020):

• Were you polite, courteous, warm, and approachable?
• How well did you accept people with different beliefs and values from your own?
• Did you attempt to understand the person and their history?
• Were you professional, open, honest, and trustworthy?
• Did you treat each person equally, providing fair access to your time and resources?

A regular check-in to ensure high standards are being maintained and values remain clear will ensure the continued professionalism expected from a social worker.

The following questions provide practical examples; practitioners should tailor them according to timing and context and remain sensitive to the needs of all involved (Rogers et al., 2020; Suppes & Wells, 2017; Davies, 2013).

Open questions

Open questions encourage the respondent to reflect and respond with their feelings, thoughts, and personal experiences. For example:

• What is your view of what happened?
• What has it been like living with this issue?
• How could we work together to find a good solution?
• What are your greatest fears?

Closed questions

Typically, closed questions are used to find out personal details such as name and address, but they can also provide focus and clarity to confirm information. Closed questions are especially important when dealing with someone with cognitive impairment or who finds it difficult to speak up, and can lead to follow-up, open questions.

For example:

• How old are you?
• Are you in trouble?
• Are you scared?
• Do you need help?

Hypothetical questions

Hypothetical questions can be helpful when we need the service user to consider a potentially different future, one in which their problems have been resolved. Such questions can build hope and set goals. For example:

• Can you imagine how things would be if you did not live with the fear of violence?
• Where would you like to be in a few years after you leave school?
• Can you imagine what you would do if a similar situation were to happen again?

Strengths-based questions

“Focusing on strengths helps to move away from a preoccupation with risk and risk management” and builds strengths for a better future (Rogers et al., 2020, p. 243). Strengths-based questions in social work can be powerful tools for identifying the positives and adopting a solution-focused approach.

Examples include:

• Survival – How did you cope in the past?
• Support – Who helps you and gives you support and guidance?
• Esteem – How do you feel when you receive compliments?
• Perspective – What are your thoughts about the situation, issue, or problem?
• Change – What would you like to change, and how can I help?
• Meaning – What gives your life meaning?

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Interventions in social work are often described as having four stages: engagement, assessment, intervention, and evaluation (Suppes & Wells, 2017).

The assessment stage typically involves:

• Collecting, organizing, and interpreting data
• Assessing a client’s strengths and limitations
• Developing and agreeing on goals and objectives for interventions
• Selecting strategies appropriate to the intervention

Assessment is an ongoing process that typically focuses on risk. It begins with the referral and only ends when the intervention is complete or the case closed.

Assessment will need to be specific to the situation and the individuals involved, but it is likely to consider the following kinds of risks (Rogers et al., 2020; Bath and North East Somerset Council, 2017):

General risk assessment

Risk management does not remove risk, but rather reduces the likelihood or impact of problematic behavior. Risk assessments are performed to identify factors that may cause risky behavior or events (Davies, 2013).

Questions include:

• What has been happening?
• What is happening right now?
• What could happen?
• How likely is it that it will happen?
• How serious could it be?

The wording and detail of each will depend on the situation, client, and environment, guided by the social worker’s training and experience.

Assessment of risk to children

A child’s safety is of the utmost importance. As part of the assessment process, a complete understanding of actual or potential harm is vital, including (modified from Bath and North East Somerset Council, 2017):

• Has the child been harmed? Are they likely to be harmed?
• Is the child at immediate risk of harm and is their safety threatened?
• If harmed previously, to what extent or degree? Is there likely to be harm in the future?
• Has there been a detrimental impact on the child’s wellbeing? Is there likely to be in the future?
• Is there a parent or guardian able and motivated to protect the child from harm?

Social workers must use professional judgment to assess the level of risk and assure the child’s ongoing safety.

Assessment process – Oregon Department of Human Services

The figures related to domestic violence are shocking. There are 1.3 million women and 835,000 men in the United States alone who are physically assaulted by a close partner each year (NASW, n.d.).

The NASW offers valuable resources to help social workers recognize the signs of existing domestic violence, prevent future violence, and help victims, including:

• We can help end domestic violence – information on how the White Ribbon Day Campaign is raising awareness of domestic violence

SocialWorkersToolBox.com is another website with a vast range of free social work tools and resources. This UK-based website has a range of videos and educational toolkits, including:

• Exploring Healthy Relationships: Resource Pack for 14–16-Year-Olds
• Parents’ Guide: Youth Violence, Knife Crime, and Gangs
• Family Meetings: Parents’ Guide and Templates
• Preventing Bullying: A Guide for Parents

Many of the worksheets are helpful for sharing with parents, carers, and organizations.

Here are three insightful podcasts that discuss many of the issues facing social workers and social policymakers:

• NASW Social Work Talks Podcast The NASW podcast explores topics social workers care about and hosts experts in both theory and practice. The podcast covers broad subjects including racism, child welfare, burnout, and facing grief.
• The Social Work Podcast This fascinating podcast is another great place to hear from social workers and other experts in the field. The host and founder is Jonathan Singer, while Allan Barsky – a lecturer and researcher – is a frequent guest. Along with other guests, various issues affecting social workers and policymakers are discussed.
• Social Work Stories Podcast hosts and social workers Lis Murphy, Mim Fox, and Justin Stech guide listeners through  all aspects of social work and social welfare.

17 Top-Rated Positive Psychology Exercises for Practitioners

Expand your arsenal and impact with these 17 Positive Psychology Exercises [PDF] , scientifically designed to promote human flourishing, meaning, and wellbeing.

Created by Experts. 100% Science-based.

Social workers should be well versed in a variety of theories, tools, and skills. We have plenty of resources to support experienced social workers and those new to the profession.

One valuable point of focus for social workers involves building strengths and its role in solution-focused therapy . Why not download our free strengths exercise pack and try out the powerful exercises contained within? Here are some examples:

• Strength Regulation By learning how to regulate their strengths, clients can be taught to use them more effectively.
• You at Your Best Strengths finding is a powerful way for social workers to increase service users’ awareness of their strengths.

Other free helpful resources for social workers include:

• Conflict Resolution Checklist Remove issues and factors causing or increasing conflict with this practical checklist .
• Assertive Communication Practicing assertive communication can be equally valuable for social workers and service users.

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit© , but they are described briefly below:

• Self-Contract

Commitment and self-belief can increase the likelihood of successful future behavioral change.

The idea is to commit yourself to making a positive and effective change by signing a statement of what you will do and when. For example:

I will do [goal] by [date].

• Cognitive Restructuring

While negative thoughts may not accurately reflect reality, they can increase the risk of unwelcome and harmful behavior.

This cognitive psychology tool helps people identify distorted and unhelpful thinking and find other ways of thinking:

• Step one – Identify automatic unhelpful thoughts that are causing distress.
• Step two – Evaluate the accuracy of these thoughts.
• Step three – Substitute them with fair, rational, and balanced thoughts.

Individuals can then reflect on how this more balanced and realistic style of thinking makes them feel.

If you’re looking for more science-based ways to help others enhance their wellbeing, this signature collection contains 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

Society and policymakers increasingly rely on social workers to help solve individual and group issues involving psychosocial functioning. But beyond helping people survive when society lets them down, social workers support them through positive change toward meaningful goals.

Social workers must be well equipped with social, goal-setting, and communication skills underpinned by positive psychology theory and developed through practice to be successful.

Reflection is crucial. Professionals must analyze their own and others’ emotions, thinking, and behavior while continuously monitoring risk, particularly when vulnerable populations are involved.

The nature of social work is to engage with populations often at the edge of society, where support is either not provided or under-represented.

This article includes tools, worksheets, and other resources that support social workers as they engage with and help their clients. Try them out and tailor them as needed to help deliver positive and lasting change and a more just society.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• Bath and North East Somerset Council. (2017, June). Risk assessment guidance . Retrieved November 17, 2021, from https://bathnes.proceduresonline.com/chapters/p_risk_assess.html
• Davies, M. (2013). The Blackwell companion to social work . Wiley Blackwell.
• Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods . Oxford Further Education Unit.
• National Association of Social Workers. (n.d.). Domestic violence media toolkit . Retrieved November 17, 2021, from https://www.socialworkers.org/News/1000-Experts/Media-Toolkits/Domestic-Violence
• Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of change. In W. R. Miller & N. Heather (Eds.) Treating addictive behaviors: Processes of chang e. Springer.
• Rogers, M., Whitaker, D., Edmondson, D., & Peach, D. (2020). Developing skills & knowledge for social work practice . SAGE.
• Suppes, M. A., & Wells, M. A. (2017). The social work experience: An introduction to social work and social welfare . Pearson.
• Thomson, H. (2010, April 14). Empathetic mirror neurons found in humans at last . New Scientist. Retrieved November 16, 2021, from https://www.newscientist.com/article/mg20627565-600-empathetic-mirror-neurons-found-in-humans-at-last/

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What our readers think.

Thanks so much for including the Social Work Podcast in this article. One correction: Allan Barsky is a frequent guest, but Jonathan Singer is the founder and host.

Hi there Jonathan,

Thank you so much for bringing this to our attention! We are delighted that you are reading the blog as we are fans of your podcast as well.

We will adjust this right away so we can give credit where credit is due 🙂

Thanks for all that you do!

Kind regards, -Caroline | Community Manager

Petra, it does not hurt to see this information again. Some social workers are new at their jobs and can always benefit from hearing this info repeated. If you want to hear from social workers only, then encourage your peers and or colleagues to write this stuff from their perspective.

This article is demeaning and patronsing! As social workers – we have done our (at least) 4 years at uni and this stuff is social work 101. As psychologists – I find you often think you know best and can “tell” other professionals how to do their jobs. So – if you want to write something to social workers – get a social worker to write it! Petra van Vliet – proud and loud social worker

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How to Write an Assessment for Social Work

Last Updated: February 2, 2023 Fact Checked

This article was co-authored by Joseph Phillips . Joseph Phillips, MSW is a Clinical Therapist and Social Worker at Transformative Growth Counseling, which is based in Illinois and Florida. He specializes in relationship and attachment therapy and treats anxiety, depression, trauma, and substance use. He earned a Master of Social Work from Tulane University in New Orleans, Louisiana, and he completed his clinical internship with Transformative Growth Counseling. Joseph is also certified in disaster and collective trauma counseling. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 308,446 times.

A social work assessment is a report written by a social worker evaluating a client’s educational, mental health, substance abuse, or occupational needs. You will need to interview the client and other significant parties knowledgeable about the client's background and current needs. The final written report includes goals the client should complete to resolve his or her problem and the treatment or assistance the social worker recommends to help the client accomplish these goals.

Social Work Assessment Template

Gathering information

• Begin by interviewing the person who is seeking services. If possible, interview family members, former case workers, physicians, teachers, and other people who can inform you of your client’s situation.

• Keep a record of all sources used for your assessment. In the assessment you will want to record who you interviewed, any incidents you were able to observe, and any documents you consulted. [1] X Research source

• Create a safe atmosphere when conducting interviews by explaining the rules of confidentiality to the interviewees. In general, all information obtained in the interview will remain a part of the report and that you will not share the information with people who are not involved with the case. If your client doesn't trust you, you will not be able to make a clear assessment.
• To elicit positive responses, focus on finding the strengths of the client. Do not apportion blame. Negotiate with the client over a mutually agreed assessment. [2] X Research source
• When you encounter resistance, be optimistic so as not to discourage your client. Continue to be polite, punctual, and attentive. Refrain from using jargon. [3] X Research source

• Have an assessment form on-hand during your interviews. Assessment forms include specific questions. Using an assessment form will help focus your interview and allow you to take thorough notes. Many facilities have their own assessment forms available for the interview process

Writing the Assessment

• Include as much information as possible. Describe the client's personal appearance, whether or not the client was appropriately dressed for the weather on the day of the interview, the client's personal hygiene, ability to maintain eye contact, and the client's mental orientation (awareness of person, place, time and event).
• Many facilities have standardized forms that direct you to describe specific questions about the client. One example of categories for an assessment include: “presenting problem,” “problem history,” “personal history,” “substance abuse history,” “family history,” “employment and education,” and “summary treatment and recommendations.” [4] X Trustworthy Source State of Michigan Official website for the State of Michigan Go to source
• Another example of such categories include: “identifying information,” “referral,” “presenting problem,” “sources of data,” “general description of client,” “family composition and background,” “educational background,” “employment and vocational skills,” “religious involvement,” “ health conditions,” “psychological background,” “social, community, and recreation activities,” “basic life necessities,” “legal concerns,” “client strengths,” “clinical summary,” and “goals and recommendations.”

• It is often best to refrain from using technical diagnoses, like borderline personality disorder. These can offend the client. Furthermore, they are often not as useful as detailed, specific characterizations of the individual in question.

• Set specific goals for the client that are time-limited and attainable. If a goal is to stop using drugs, for example, your treatment recommendation should include a referral to a substance abuse program that requires the client attend a set number of meetings and submit to random drug screenings, and a target date for completion of the program.

• Compare and contrast the client's perception of his problems, needs, weaknesses and strengths with the perceptions of other people you interviewed for the assessment. Such a comparison can provide you with a more complete understanding of the client's goals and treatment needs.

• Schedule a follow up meeting with the client after you've written and discussed the assessment to review the client's progress towards completing each goal. Return to the assessment periodically to evaluate the client’s development

Community Q&A

• A social work assessment may also be referred to as a needs assessment or a mental health assessment. Thanks Helpful 0 Not Helpful 0
• An assessment that focuses primarily on a client's drug and alcohol problems is a substance abuse evaluation. Thanks Helpful 0 Not Helpful 0

Things You'll Need

• A safe, secure interview room
• Medical and educational records
• Assessment form

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Expert Interview

Thanks for reading our article! If you'd like to learn more about social work nuances, check out our in-depth interview with Joseph Phillips .

• ↑ https://www.proceduresonline.com/stockport/cs/chapters/p_assessment.html
• ↑ https://us.sagepub.com/sites/default/files/upm-binaries/62946_Lishman.pdf
• ↑ https://www.michigan.gov/-/media/Project/Websites/mde/specialeducation/approvals/SSWCompetencyEvaluationForm.pdf?rev=5ece7f91c88e4a57a36b7c0da6221430
• ↑ https://positivepsychology.com/social-work-toolbox/

About This Article

To write an assessment for social work, try to include as much of the information you gathered during your interviews and research as possible so your assessment is specific. You should also mention the issue the client is dealing with, but in a way that won't offend them. Try to focus on the client's strengths and discuss how they can be used to improve their condition. Also, include any recommendations you have for the client and goals you'd like them to work toward. To learn how to gather all of the information you'll need to write your assessment, keep reading! Did this summary help you? Yes No

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British Social Work: Risk Assessment and Management Essay

Introduction.

This study paper looks at British social work and specifically concentrates on adult disabilities and tries to answer the question on whether assessment and management of risk in social work with disabled adults can be described as a complex and problematic phenomenon.

A number of materials-books and journals will be used during the research of this subject. The utter generality of the ongoing cultural debate about organizations and personification has predestined that all facets, phase, or parts of social work have been influenced by it and the UK has not been left behind as its impact has certainly not been confined to those working in the new ‘adults’ social services departments.

Assessment and management of risk in social work with disabled adults can be described as a complex and problematic phenomenon

Social workers as professionals are required to be persons who are strong willed and have the desire to be of assistance in the improvement of other people’s lives especially those with disabilities. For that reason, social work as a professional career for any individual entails provision of help, provision of solutions to personal problems such as personal, family and relationship matters to people in their everyday lives.

Furthermore, social workers are also involved in providing help to disabled people, or persons dealing with life threatening or fatal diseases and cases where social problems come into play such as drug abuse and unemployment. Consequently, social workers wind up being connected with or participating in research studies either as subjects or conductors of the study itself, advocates for an improvement of services and policy development/planning involvement (Priestley 2003).

In essence, social work is concerned with providing and making available their services to a specific target populace. They are by and large, concentrated in diverse areas of practice in relation to a person’s inclination and capability. The areas of expertise found under social work fall under political, mental health, elderly, slums dwellers, medical and education. If they have the right State mandated license, these workers are referred to as licensed clinical social workers in spite of whichever setting they are in (Oliver & Sapey 2006).

During the last decade, the viewpoints and principles of the Independent Living Movement have had a considerable power to influence people’s perceptions or deeds by way of dispute, for example, or vigor of character in regard to social work in the area of adult disability.

A shift in practice has been observed from establishment of clients who are reliant on services offered by professionals, to formation of working partnerships with the disabled people in question. This is happening so as to be able to secure the rights of adults with disabilities to be recognized as equivalent citizens of a state (Thomas 2003).

Notwithstanding the shift observed in the last ten years or so, there has also been a substantial sudden increase of attention being heaped on the health, well-being and the embodiment of the nature of social experience (Oliver 1990).

These signs can be witnessed just about everywhere around us. Intellectuals round the world have been engaged in debates over the nature, implication and reason of human life for taking place as the ‘Darwinian theory versus the bible’ debates of the late 19th century have somehow also engaged debates about the connection between humankind and the human body.

These debates take up a scientific, philosophical and theological dimension. Simultaneously, balancing, holistic, mind or body psychotherapies are more and more becoming common. In the UK, media stations have diverted much attention to more attractive reports like corpulence, ‘size zero’ models and celebrities drug abuse (Thomas 2003).

A study/inspection of social services carried out by the Social Services Inspectorate (SSI) shows that only an eighth of the eight departments surveyed had a plan definite for the disabled adults. The inspection carried out was to assess the services and help offered to support parenting roles of adults with disabilities (Warren 2007).

This led to recommendations being put forward on shifting the outlook in approach of provision of services to working with the disabled persons by recognizing their right to be offered support to accomplish their responsibilities as parents. In addition to this, strategy and policy development to improve ‘joined-up working’ across adults’ and children’s service divisions and between agencies were to be formed.

The 2007 UNICEF report on children in the UK and the USA, reveal the position children occupy to be at the bottom of the list in developed countries in conditions where a range of indicators of health and well-being were in play. Sizeable soul-searching by observers has been motivated in the path of which ‘wellbeing and happiness’ became bundled to nearly all aspects of becoming adults in the society, including offenses, cruelty, the impoverishment of children and the apparent ‘break-down’ of family ties.

There was appeal for information-specified parents who had bodily and sensory incapacitation and or parents with learning incapacitations to evade replicating functions done by the National Institute of Social Work.

In respond to this, in 2002 the Rowntree Foundation set up a task force named, Supporting Disabled Adults In Their Parenting Role, to survey and try to shed some light on how many social services departments in Britain had policies and protocols that covered disabled adults (parents) and how far they were likely to address anxiety raised by the inspectors and by disabled parents (Johnstone 2001).

The responses obtained from about 125 departments visited showed that thirty one of these departments had policies still in draft forms or early stage of implementation. An additional twenty nine departments were either in the process of laying down policies or were planning to do so. On the other hand, sixty three of the departments had no immediate plans to come up with policies. This clearly shows a worrying trend in provision of social services to adults with disabilities (Brown 2003).

Assessment carried out on children alone and not on disable parents and their entitlement to social service provision, can turn out to portray the children as ‘in need’ or ‘at risk’ or as ‘young carers’ (Rapley 2004). Although social services departments are aware that disabled adults are wary of approaching social services for support with parenting, they more than often seem to be taking few measures to allay these fears.

The Community Care legislation was introduced to support social services, together with provision of support to disabled adults to fulfill their parenting roles and responsibilities.

This is weighed down by a persistent complexity brought about by policies and protocols, which indicated that where parenting roles are left out of eligibility criterion for Community Care services, disabled parents would either not reach the threshold for receiving Community Care services or would not receive the extra attention necessary to meet parenting needs as well as personal needs (Shakespeare 2006).

The fairly less attention put on Community Care legislation and the role of provision of professional support to adults with disabilities compounded with the importance on children’s legislation, may suggest an easy slip away from the agenda of providing support for disabled adults in their parenting role and be replaced with alarms over children’s welfare.

Making certain that participation between professional social workers with adults with disabilities the whole time contact with the family is maintained, as well as cases where concerns of child protection may arise, provides for the best opportunity of guaranteeing stability of support being given to the parent and a better relationship between disabled parents and social services (Williams 2006).

Most of these policies articulated clear and precise objectives to provide and support disabled parenting. Nonetheless, the legislative routes to be utilized were not very clear.

This was particularly obvious in regards to adult community care legislation. The report by the Joseph Rowntree Foundation found out that just about two-thirds of those that responded adult based social workers. However, in terms of the documented plans and procedures, reference to children laws together with children protection actions were usually many, explicit and potent. Unlike references to adult laws and regulation, which were normally dispersed and diffuse.

Social workers have in recent times become more occupied with challenge of how to smooth the progress of movement from ‘structured dependency’ to ‘the realization of human rights’ (Oliver 1990). The disability and equality act 2010 that replaced the disability discrimination Act defines a person with disability as one who suffers from physical or mental impairment and if it has a substantially long term adverse effect on them.

Outcomes-focused assessment

Buoyant due to the views that social service demands an enabling of adults with disabilities to accomplish their everyday tasks and roles linked to their quality of life; researchers into social work and its dynamics are questioning the basics about the evaluation. For instance, on the basis of their work with young people, many of whom had complex health care needs, which Gates (2006) argues that there should be a new ‘outcomes-focused practice’.

Provided that the formation of assessment models is based on the notions of ‘need’, they will continue to be in conflict with the new attitude of ‘personalized social care’. To support this, studies go on to point out the course of action in identifying ‘needs’ without a doubt engages prejudiced judgments on the part of the professionals concerned. This subjectivity is argued that it creates a professional ‘problematic’ concept.

Developing a model or framework for health and disability necessitates a foundation of positive vision with the sole function of embracing hopes, aspirations and quality of life rather than looking to only deal with short term problems and shortfalls.

Engaging of older people together with professionals in the redesigning of models of health and social risks and needs appraisal and assessment proved to be productive. It shows that the accessible expertise could be customized (at a conceptual level) to produce a mechanism that has the potential of improving adults with disabilities access to social services and information.

Studies and researches carried out on health; show an interrelation between health and disability. The UK among others has recently come up with policies and legislations in an attempt to extend disability rights, outlaw discrimination on the basis of disability and fight some of the most apparent types of stereotypical social exclusion.

British social work has transformed into social care service providers with an aim of providing ‘accessible’ and ‘person-oriented’ attention, though there have been several efforts to breakdown synthetic obstacles between health and social care professionals.

The nineties saw the United Kingdom come up with premeditated models of assessment on a needs-led principle assessment meant to ensure social care services were integral to adults with disabilities rather than the other way around. This idea should therefore have amplified the position of evaluation of administration of risk in social care organization development with the goal of autonomous alliance with the social representation of disability. However as commonly perceived, this has not been occurring due to the concept of ‘need’.

It is worthy noting that the principle of assessment goes further than just simply being in contention that social workers need to pay attention to what disabled service users desire. This approach to assessment is entirely quite new. Its application in health and disability does not sort out the desires and perceptions of service users say through the idea of ‘need’.

By and large, this principle has been expressed as an ‘outcomes-focused’ form of assessment whose foundation is hinged on the initiative of exploring together with adults with disabilities the wouldesired outcomes’ that would really have an effect on their day to day lives and then utilizing these wouldesired outcomes’ as a focus point of carrying out assessment.

These assessments can only be carried out through a partnership with the service users and complete consultation from other qualified persons, as they would necessitate a variety of diverse responses from a large assortment of organizations. As a result, option, empowerment and coalition might in reality be fully realized as a means of evaluation (Rothman 2004).

At this moment in time, the outcomes assessment model is immature and is beset by a myriad of apparent problems. It is neither clear how ‘preferred outcomes’ can be fixed into a legal structure of enforceable privileges; nor is it visible how or if the evils connected with the allotment of inadequate services will be influenced by the end objective. Nonetheless, the new model has already changed the way in which discussions of evaluation perceptions are approved despite its present representation state (Hodges 2003; Leslie 2004).

As it might be expected, there are various developing debates which indicate feasible results expressed in our minds by the ‘outcomes for children’ model. The focal point of every child is important, and recognized as government efforts to re-conceptualize specialized performance among social workers that shares to the set out progressive series of effect for children and young people alike.

In addition, an exceptionally essential discrepancy between the proposal for an ‘outcomes-oriented’ application in the health and disability discipline and the ‘outcomes for children’ noted in ‘Every Child Matters’ is evident. Until now, no-one has been able to advocate for ‘outcomes’ for adults with disabilities.

Whilst there is continuous debate and uncertainty whether the assessment and management of risk in social work with disabled adults results to being a complex and problematic phenomenon the possibility for a holistic, well-timed and suitable family support from the family by social workers can only be realized where an understanding of the role of supporting parents in safeguarding the welfare of their children is in place and probable actions are undertaken to maintain the right of disabled adults to receiving of assistance to their parenting tasks and responsibilities. There is growing concern around the world on meeting the needs of disabled adults in a harmonized way.

Nevertheless, unanswered concerns regarding the most suitable way to widen work across adults’ and children’s divisions still abound. The 2002 study carried out by the Rowntree foundation clearly shows a worrying trend in provision of social services to adults with disabilities. In addition, to this a study carried out by the Social Services Inspectorate (SSI), also found out the trend among social services department of not having drawn up specific policy plans that were particularly tailored to provide social services to disabled adults.

In light of this scenario, assessment and management of risk in social work with disabled adults could and can be described as a complex and problematic phenomenon, due to the dynamics involved, but is very necessary so as to avoid persistence of child poverty and the perceived ‘breakdown’ of family life in addition to cases of lack of provision of social services to disabled adults resulting to a concern for child protection.

Recognizing the barriers created by social care services and how they can be identified is a sure way of making certain that assessment is not turned into an unrecognizable phenomenon.

Brown, I., 2003. Quality of Life and Disability: An Approach for Community Practitioners. London: Jessica Kingsley.

Gates, B. (ed), 2006. Care Planning and delivery in Intellectual Disability Nursing . Oxford: Blackwell.

Hodges, S., 2003. Counselling Adults with Learning Disabilities. Basingstoke: Palgrave/Macmillan.

Johnstone, D., 2001. An Introduction to Disability Studies . London: David Fulton Publishers.

Leslie, J., (ed) 2004. Care of the Adult with a Chronic Illness or Disability: A Team Approach . St. Louise: Elsevier Mosby.

Oliver, M., 1990. The Politics of Disablement. Basingstoke: MacMillan.

Oliver, M. & Sapey, B., 2006. Social Work with Disabled People . Basingstoke: Macmillan. 3rd Edn

Priestley, M., 2003. Disability: A Life Course Approach . Cambridge: Polity.

Rapley, M., 2004. The Social Construction of Intellectual Disability . Cambridge: Cambridge University Press.

Rothman. J. C., 2004. Social Work Practice Across Disability. London: Allyn & Bacon.

Shakespeare, T., 2006. Disability Rights and Wrongs . London: Routledge.

Thomas, D., 2003. Working with People with Learning Disabilities: Theory and Practice . London: Jessica Kingsley.

Warren, J., 2007. Service User and Carer Participation in Social Work . Exeter: Learning Matters.

Williams, P., 2006. Social Work with People with Learning Difficulties . Exeter: Learning Matters

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1. IvyPanda . "British Social Work: Risk Assessment and Management." April 2, 2022. https://ivypanda.com/essays/social-work/.

Bibliography

IvyPanda . "British Social Work: Risk Assessment and Management." April 2, 2022. https://ivypanda.com/essays/social-work/.

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• v.8; Jan-Dec 2022

Assessing Older Community Members Using a Social Work Tool: Developing an Organizational Response

Rajna ogrin.

1 Bolton Clarke Research Institute, Level 1, Forest Hill, VIC, Australia

2 Griffith University, Brisbane, QLD, Australia

Claudia Meyer

3 La Trobe University, Bundoora, VIC, Australia

4 Monash University, Frankston, VIC, Australia

Aliki Karantzoulis

5 Bolton Clarke, Bundoora, VIC, Australia

Isabel Jane Santana

6 University of Melbourne, Parkville, VIC, Australia

Ralph Hampson

Associated data.

Supplemental material, sj-docx-1-ggm-10.1177_23337214221119322 for Assessing Older Community Members Using a Social Work Tool: Developing an Organizational Response by Rajna Ogrin, Claudia Meyer, Aliki Karantzoulis, Isabel Jane Santana and Ralph Hampson in Gerontology and Geriatric Medicine

Supplemental material, sj-docx-2-ggm-10.1177_23337214221119322 for Assessing Older Community Members Using a Social Work Tool: Developing an Organizational Response by Rajna Ogrin, Claudia Meyer, Aliki Karantzoulis, Isabel Jane Santana and Ralph Hampson in Gerontology and Geriatric Medicine

Social Worker’s undertake psycho-social assessments and facilitate access to evidence-informed psychological and practical supports to optimize the physical, psychological, and social wellbeing of the community members in their care. Social workers employed at an aged and community care organization undertook a review of the gray and peer reviewed literature and did not identify any existing evidence-based tools. However, 10 key domains were identified from the search. Gaps in the domains were discovered, together with the need for guidance and prompts for less experienced staff and students. Five Social Workers, using co-design principles, reviewed the domains, and added further domains from their social work practice. An evidence-based assessment tool was developed which incorporated 11 domains. The tool can be used to assess the needs of people living in the community who are older and/or have compromised health and wellbeing. Further work is required to pilot test the tool.

What This Paper Adds

• No evidence-based psycho-social assessment tools exist to guide social workers working in aged and community care;
• An 11-domain Social Work assessment tool has been compiled, together with guidance questions, specifically for use in the aged and community care context, by practitioners with variable levels of experience;
• Inclusion of Social Workers who would utilize the tool ensured the translation of evidence into a fit-for-purpose assessment tool.

Applications of the Study Findings

• This tool was developed with social workers, for social workers, and includes the domains most relevant to maintaining independence and optimizing holistic wellbeing for people living in the community who are older and/or have compromised health and wellbeing.
• Further work is required to field test the tool, to ensure that it captures meaningful data for the development of effective management plans and interventions in partnership with the person seeking support and their family or carers.
• This tool has the potential to be used by nurses and other healthcare providers who wish to conduct holistic psycho-social assessments.

Introduction and Background

Social workers play a central role in the assessment of people who are older and/or have compromised health and wellbeing, both in the community and in hospital settings. Social workers are “context specialists” and seek to understand the needs of these people by considering the micro, macro, and meso factors that impact on a person’s life ( Austin et al., 2016 ). Social Work is informed by a holistic understanding of the “person in environment.” Practitioners assess situations to identify the most appropriate interventions in partnership with service users. Aligned with this perspective, assessment in Social Work is underpinned by the bio-psycho-social approach ( Whittington, 2007 ).

Australia, like other countries worldwide, has an ageing population and a significant population with compromised health and wellbeing. Australia’s aged care system provides services that range from basic supports to enable people to remain independent at home, through to living in a residential aged care home with access to full-time care ( Australian Institute of Health and Welfare [AIHW], 2021a ). Most people want to remain living at home, and most aged care is provided to people in their homes to support them to do this ( AIHW, 2021a ). As people grow older, multimorbidity and psychosocial issues may increase, leading to more complex care needs ( McGilton et al., 2018 ; Thiyagarajan et al., 2019 ; World Health Organization [WHO], 2015b ). It is not only older people with compromised health; more than 50% of Australians reported at least one chronic condition in 2014 to 2015 ( AIHW, 2021b ). While chronic conditions impact all Australians, those people living in a situation where physical environment, social and cultural determinants, and biomedical and behavioral risk factors interact to increase their likelihood of poorer health outcomes ( Brotherhood of St Laurence & MIAESR (Melbourne Institute of Applied Economic and Social Research), 2019 ). Therefore comprehensive assessments to identify issues and develop plans to address them would be required, and assessment tools would support this complex activity ( Taylor, 2012 ).

The Australian Association of Social Workers (AASW, 2015) has published Scope of Social Work Practice: Aged Care . This document recognizes this area of practice is vast, but the work of social workers includes “assisting older people, and in some cases their families, to make significant life decisions based on the best aged care related information and resources available (p4). ”

There are currently no evidence-based assessment tools available to social workers to work with older people incorporating needs of those with compromised health and wellbeing in the community. Social workers currently undertaking assessment and management of people living in the community who are older and/or have compromised health and well-being in an aged and community care organization, identified the lack of evidence-based tools available to them. This project sought to address this gap.

The available literature, practice guidelines, and resources used by social workers in the practice setting were interrogated. A purposive sample of social workers, working in aged and community care, were asked to review and refine the collated information to assist in the development of the proposed tool using a co-design approach. Co-design is a way for individuals with expertise to work together collaboratively. It involves the inclusion of both explicit (e.g., sourced from literature) and tacit (e.g., insights and experiences) forms of knowledge (e.g., as identified through literature or clinical guidelines), where they are complementary in the synthesis into new knowledge ( Bennett, 2011 ; Rynes et al., 2001 ). Outputs from a co-design process are likely to be fit-for-purpose, acceptable, valuable, and enduring ( Greenhalgh et al., 2016 ). Our approach draws on the Double Diamond design framework, with four phases of: (1) Discover; (2) Define; (3) Develop; and (4) Deliver (adapted in Figure 1 below), with this paper outlining the first three phases.

Adapted co-design framework (reprinted Figure 1 . Adapted co-design framework from Meyer et al. (2022) .

Phase 1: Discover

This phase gathered (i) information and insights from the literature and (ii) incorporated experience-based design ( Donetto et al., 2014 ) to understand the experience of social work assessment from the perspective of staff undertaking assessments in the field.

A review of the literature

A comprehensive search of the literature was conducted to, firstly, identify any pre-existing social work assessment tools applicable to the community aged care sector. Electronic databases (SocINDEX, CINAHL, Psych-Info, Health, and Society) with key words (and derivatives) of social work assessment, aged, and community were used. Papers published in the English language, between 2008 and 2018 were retrieved. Hand searching of reference lists of the relevant articles was conducted, along with a review of gray literature. Titles and abstracts of studies were screened for inclusion by two reviewers (author CM and a Master of Social Work student), with discrepancies resolved through discussion.

Secondly, the same literature search was used to identify relevant domains for social work practice.

Engagement with community-based social workers and exploration of their experiences

Within the Australian aged care system, older community members wishing to receive services are directed through the My Aged Care portal for a comprehensive generalized assessment ( Commonwealth of Australia, 2021 ). Following this assessment, referrals to appropriate services, including social work, are made. This generalized assessment is critical for optimal care but does not include social work specific items necessary for best practice when working with older people in the community.

In response to a lack of consistency in social work assessment across an aged care provider, and limited best practice guidance for less experienced aged care social workers, a working group of eight people was convened to address this issue. As the activities of this project were less than low risk, it was deemed a quality improvement activity and did not require Human Research Ethics Committee review. The working group comprised social workers ( n  = 2), an operational manager ( n  = 1), researchers ( n  = 2), and Masters of Social Work students ( n  = 2). This group was tasked with identifying current social work assessment practices across an aged care service organization in Melbourne, Australia. In addition, all members were asked to identify other community-based social work assessment tools through their professional networks.

Once this work was completed, the working group engaged with all the social workers working in the organization ( n  = 5) to seek further information and clarification of current social work practices in a focus group. This focus group explored: (a) positive and negatives aspects of the tools and resources available; (b) challenges for students and less experienced social workers when using the tools and resources; and (c) potential opportunities for improvement.

Phase 2: Define

This phase synthesized the outcomes of the literature review, both for overall social work assessment tools and the optimal domains within a tool. Domains identified in the previous work were discussed with the working group and in a second focus group with the Social Workers. The following questions were posed:

• Do these domains comprehensively address social work concerns in the community?
• Are there any domains currently not included?
• What detail is needed to guide correct assessment of the domains?

Phase 3: Develop

Next, members of the working group used information from the literature review and focus groups to guide specific questions for each domain. Research team members were responsible for searching for any validated screening tools to support the assessment of these domains (e.g., the Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive screening instrument validated in populations where cultural learning and language diversity occurs ( Storey et al., 2004 ). A third focus group with the social workers reviewed the information collected and provided feedback and analysis to form a final version.

An initial search strategy retrieved 420 articles which fitted the inclusion criteria. After eliminating duplicates and screening titles for relevance, 419 abstracts remained for review. Of these, six met the eligibility criteria for inclusion, see Table 1 below. A review of documents within the gray literature related to aged care assessment identified three more resources: The NATFRAME (National Framework for Documenting Care in Residential Aged Care Services; Department of Health and Ageing, 2005 ); The Assessment for the Aged Care Assessment Program (ACAP), developed by the University of Wollongong ( Sansoni et al., 2010 , 2012 ); and The NSAF (National Screening and Assessment Form; Australian Government, 2018 ). The NATFRAME included assessment tools for four domains: social, cultural and spiritual, physical and functional, and cognitive and mental domains; The assessment for ACAP also included four domains, but these were slightly different: physical, cognitive, behavioral, and psychological and social domains; while the NSAF included five domains, which were: Social, Physical, Medical, Psychological, and complexity/vulnerability domains.

Assessment Tools in the Community Aged Care Sector Applicable to Social Work Identified in the Peer Reviewed Literature.

Engagement with community-based social workers and exploration of their experiences: Existing assessment tool feedback

Social work staff articulated that the existing holistic assessment tool used by the aged care service included comprehensive and useful clinical information that impacted the lives of the community dwelling members they were assessing. However, the existing tool was not meeting the needs of the social workers, with staff using “cheat sheets” to enable them to collect the information that would inform their care. An example of the content of an existing cheat sheet is shown in Box 1 . The social workers raised two key areas needing improvement:

Social Worker “Cheat” Sheet in use.

1. The need to take a biopsychosocial approach

The existing form heavily emphasized clinical information, whereas it is the social impact on health outcomes and status that is central to social work practice. Exploring with the older person what is most important for them is central to a holistic assessment. This approach enables a better understanding and prioritization of what is most important to the. community member, leading to the most effective support provision. There appears to be a disconnect between the clinical care of nurses and the psycho-social approach of social workers, with the value of a holistic, biopsychosocial approach underestimated.

2. Need for guidance of less experienced staff

Sensitivity to the emotional and mental health needs of the person seeking support is complex. Beginning practitioners and students new to this field of practice will require education and guidance to effectively undertake this work. Prompts and guides would enable students and less experienced social workers to sensitively draw out information from community members. This would enable them to develop their skills, and better identify the needs of older community members.

Literature review and synthesis

The articles identified in the literature search provided some information on assessment tools that could be used by social workers. These included generalized assessment tools ( Craig et al., 2015 ), a screening tool to assess safety of independent living ( Mills et al., 2014 ), integrated care assessment tools ( Taylor, 2012 ; Warburton et al., 2015 ), a spiritual assessment tool ( Harrington, 2016 ), and comprehensive assessments of older people with complex needs ( Australian Government, 2018 ; Lambert et al., 2009 ; Sansoni et al., 2012 ), shown in Table 1 . There was limited access to the tools referred to in the publications, and included questions or domains were generally not provided. No validated social work assessment tool was identified that could be used when working with people living in the community.

The synthesis of the research and tools in the literature review identified the following 10 key domains for inclusion in a comprehensive Social Work assessment tool for older people: (1) Identifying the reason for the contact; (2) Physical health; (3) Cognition/Decision making; (4) Mental health/emotional wellbeing; (5) Functional profile; (6) Mobility; (7) Religion (culture)/Spirituality; (8) Finances/Work/Living Arrangements; (9) Relationships/Sexuality; and (10) Friendships/Social Connections/Supports. These are described in Supplemental Appendix 1 .

Focus groups with social workers

The 10 domains identified in the literature review synthesis were discussed with the working group. This group also reviewed existing social work/complex care assessment forms used by local services ( n  = 4). The group identified that a reworking and addition of four domains would better address psychosocial concerns (1. Functional profile; 2. Communication and sensory function; 3. Physical Health; 4. Pain; 5. Sleep; 6. Nutrition; 7. Continence; 8. Mobility; 9. Mental Health; 10. Social; 11. Cognition; 12. Living Arrangements and Finances; 13. Carer profile; and 14. Hoarding and Squalor), and a draft form was developed with 14 domains. Further, to guide correct assessment the draft also included the addition of guiding questions for social workers.

Researchers presented the assessment form to five social workers, with an average 20 years working as social workers and have worked at an average of 10 years in the current organization. The feedback was used to adapt the form, and a second version was sent for feedback. The final version included the 11 domains shown in Table 2 , and the full tool is shown in Supplemental Appendix 2 .

Social Work Assessment Tool Final Domains for Inclusion, With Sub Domains.

The recommendations for guidance involved two components: (1) Supervision: It was considered highly beneficial for new staff and those less experienced to have supervision by a more experienced social worker to discuss clients and how they can engage with their client, evaluate, or continue to progress through the assessment depending on time and capacity of the client; (2) Prompts within the tool: The tool can also be used as a prompt for conversations and engagement. Not every aspect of the tool needs to be filled in and it should be used with flexibility depending on client’s circumstances and needs.

Instigated by social workers and using both evidence and practice-based experience of practitioners working in aged and community care with older people and those living with compromised health and wellbeing, a social work assessment tool was developed. The proposed tool includes 11 domains which social workers can use in practice to identify comprehensively and sensitively what is important to older community members, as a basis for developing an intervention plan to address their wellbeing needs. The additional guidance recommendations include supporting less experienced social workers and students through supervision to enable them to undertake these assessments comprehensively and effectively, developing key skills to support care plan development. Further, the tool includes questions that can be used as prompts for guidance. This work provides the foundation for further validation of the tool and its implementation in clinical practice with a larger sample of social workers from other age and community care organizations to confirm face and content validity and perform construct and criterion validity and reliability testing.

Research regarding specific social work assessment tools to be used with community dwelling older people is limited. Peer reviewed literature describes a range of holistic tools, including a general geriatric assessment ( Craig et al., 2015 ), integrated care ( Taylor, 2012 ; Warburton et al., 2015 ), and comprehensive assessments of older people with complex needs ( Australian Government, 2018 ; Lambert et al., 2009 ; Sansoni et al., 2012 ). However, a discipline specific tool to guide social work assessment when working with older people in the community is currently not published, and access to the tools described in existing publications is limited. To ensure accessibility of the work done in this paper, we have included the full version of the tool in Supplemental Appendix 2 .

To support optimal wellbeing among older people, a comprehensive community-based assessment is crucial, incorporating assessment of an individual’s needs, development and implementation of a care plan, provision of monitoring and referrals as needed, and supporting informal caregivers ( Thiyagarajan et al., 2019 ). There are substantial limitations in the existing Australian health and aged care system regarding the provision of comprehensive assessments, and coordination and delivery of services, that is, person-centered, integrated care ( Royal Commission into Aged Care Quality and Safety, 2021 ; WHO, 2015a ). Across the globe, governments increasingly recognize that prevention and early intervention are key ( WHO, 2020 ). This is in line with Australian Government reform ( Department of Health, 2021 ; Primary Health Reform Steering Group, 2021 ); striving for a system that focuses on timely assessment rather than crisis management ( Primary Health Reform Steering Group, 2021 ). There is momentum to consolidate and integrate existing primary care services, where the majority of Australian healthcare is provided, with a “supporting maintenance of wellbeing” approach rather than a “responding to illness” focus ( Primary Health Reform Steering Group, 2021 ). Social workers are well placed to co-ordinate the holistic care needs of individuals, including planning for current and future need ( McGilton et al., 2018 ). The existing reactive approach will require change ( Primary Health Reform Steering Group, 2021 ) at the individual, healthcare provider, and system level ( WHO, 2020 ). A structured assessment tool, with its focus on holistic care needs that also pre-empts wellbeing concerns, is a step toward this goal.

A co-design approach underpinned this work, driven by the need and desire of social workers within an aged care organization to improve their practice. Engaging the users of the tool in the development ensured that it included relevant components and was fit for purpose ( Greenhalgh et al., 2016 ). Further co-design work with older people and a broader network of social workers is needed to ensure it adequately meets the needs of all stakeholders. A further strength of this work is that the tool is geared to assessments being done in the homes of older people where, in the main, older people seek to remain as they age ( Commissioner for Senior Victorians, 2020 ). Remaining at home may require health and aged care support, with this assessment tool providing the necessary person-centered review of their home and social context.

A limitation of this tool is the lack of a mechanism of integrating social work assessment with other multi-disciplinary assessments for comprehensive care delivery to service users. Social Workers have a focus on psychosocial needs to promote wellbeing, and on justice in society ( AASW, 2015 ). Given the significant impact of social determinants of health on the wellbeing of community members service users will often require assessments with a number of health and community workers ( WHO, 2020 ). The need to integrate social work assessments with other assessments is an area that requires further investigation (Kangasniemi et al., 2021).

Social workers are key members of multi-disciplinary teams that work with older people in the community. This paper describes how an assessment tool was codesigned with and for social workers working in the field of aged care. This assessment tool aims to enable holistic assessment of older community members through incorporating 11 domains identified and includes questions to guide novice or student social workers; identified as important by social workers engaged in providing care for older community members. The assessment tool supports social workers to be more proactive in building partnerships with older people to focus on early identification of issues, proactive planning, and engaging people to make informed and educated choices to shape later life and mitigate against the risks that can occur and have been identified in the literature. The next step would be to pilot test the tool in practice with service users to further validate the tool, its implementation, and assess its efficacy in clinical practice with a larger sample of social workers from other age and community care organizations.

Supplemental Material

Acknowledgments.

University of Melbourne Masters of Social Work Students Isabel Santana and Emily Clarke.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

IRB number: NA. This work is a result of a quality improvement activity involving co-design, and as such did not require ethics approval as advised by Bolton Clarke Human Research Ethics Committee.

Supplemental Material: Supplemental material for this article is available online.

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