Observations, assessment tools and questioning
Assessment involves some form of study in which the workers/agencies involved gain a picture of the client, the situation, the current problems/issues they are facing and any relevant environmental factors.
The major purpose of this early assessment is to obtain information, to gain knowledge and understanding of the person so you can assist them and guide possible intervention.
Your role within your agency will determine the amount and depth of information you require about a client and their situation. When a client first accesses a service, the worker fulfilling an intake role must gather extensive information in order to:
- gather all the relevant facts
- gain a clear or clearer understanding of the client’s issues
- support the client in staying focused and standing a little outside the situation to get clear facts.
Accuracy in gathering information is vital to protect both the client and you. Remember that the information will be used to assess the client’s situation and level and immediacy of intervention. You need to gain all the necessary facts without sensationalising, or making light of, the situation as it presents for the client. This is especially so when you are gathering material that could be used as evidence in a court.
There are a number of ways you can make sure that you obtain factual information. These include the following:
- noting how the client presents
- informing the client of your role
- allowing time for the client to present the information fully
- asking the right questions in the right manner
- listening to the client’s story
- saying what you are interested in finding out
- observing the client’s behaviour during the interview.
Noting how the client presents
When meeting a client for the first time, or talking to them on the telephone, you will gain a first impression of them based on such things as:
- mental state (irrational thinking, memory loss, delusions, etc.)
- emotional/psychological state (highly distressed, anxious, withdrawn, etc.)
- personal circumstances (no home, no money, no food, etc.)
- support networks (Do they recognise anyone in their life who could help?)
- indicators of abuse.
Inform the client of your role
Occasionally clients have been misdirected to your agency, and their expectation of the assistance available does not match the resources and responsibilities of your agency. The Intake Officer or person initially interviewing the client can usually determine this very early in the process and prevent the client having to go through their story in depth when a referral to another agency would be more appropriate. Hence it is important that workers clarify to the client their role and the role of the agency as soon as possible.
In the case of a person contacting your agency about a child or young person at risk or a person with a disability at risk, make sure that you spend a moment explaining to the person your role and the role of your organisation, to ensure they are reporting to the most appropriate service.
Allow enough time
To go through all the processes of obtaining information will require time. Make sure that you have allowed enough time to thoroughly evaluate all the information that the person has given you, to confirm that what you have recorded is a true statement of what the person said.
It is not uncommon for an interview over the telephone to last more than one hour. It may then be necessary for you to do some follow-up to verify the claims. Do not rush this process as you may leave out important information.
Listen to their story
You need to be patient and calm when conducting an interview with a client who is distressed. You need to give the client a clear message that you are listening to their story.
This can be done through:
Your body language
Appear interested; adopt a relaxed and yet attentive body posture; observe the tone, volume and stability of your voice; be aware of your responses to some of the information the client is telling you; and ensure they are appropriate.
In western culture, maintaining eye contact suggests we are interested in and attending to the client; however, do not stare. Ensure eye contact is natural and direct. Be aware of racial, age and gender differences. Be sensitive to your client’s responses and be guided by those responses.
Developing rapport and providing a trusting environment
In order to build rapport with a client, you must appear to be genuinely interested in them. This can be demonstrated in small ways, from ensuring there are no distractions during your interview, checking that they are comfortable, and checking how they wish you to address them, to speaking respectfully to them and allowing them to adopt a measure of control within the interview. Trust can only develop over time and you should be vigilant in ensuring that any actions/plans you offer to undertake on behalf of the client are completed in the time frame specified.
Every interview or contact gives you an opportunity to learn more about your client; hence your communication should demonstrate respect for a client’s opinion. You can achieve this by listening to their ideas and points of view, accepting that you will have differences of opinions and values and not overreacting to a client’s behaviour or statements. Be genuinely interested in how that client acquired those beliefs; this helps in understanding the client holistically.
Use short acknowledgements such as 'Eh' and 'I see'.
Rephrase what the client has said to ensure you have understood correctly.
Summarise what the client has said at the end to ensure you have the main points.
It is important to make the person feel as comfortable as possible and free to express their thoughts and feelings.
Click in the image below for more information on body language.
Read the case study below and then the reflection that follows
Karen works with Sarah, who is 19 years old and has an intellectual disability. Sarah has come to see Karen because she has had sex with a boy from her workplace and is very upset about it. Karen asks Sarah to tell her what went on and gives her the space and time to tell her story in her own words before she intervenes with any questions or asks for any clarification.
Reflect on how you might deal with this situation and make some notes in your reflective journal. As you work through this unit, you may like to add strategies and methods used to deal with this and other situations.
Giving people the space and opportunity to talk about difficult topics will help them to feel that what they are saying is important and that they are being listened to and believed.
Maintaining the focus of your interview
It is very important to ensure that your interview does not become an inquisition: while there will be important information you need to gather, it must be acquired sensitively without putting undue pressure on the client. Open and closed questions allow for a balanced information-gathering process.
Closed questions are those questions which usually have only a brief response, e.g. ‘Are you receiving Centrelink payments?’. This can only be answered with a ‘yes’, ‘no’, or ‘I have applied’ answer. These questions are very useful in gathering factual information from a client, e.g. in relation to employment status, financial support, address, family composition, etc.
However, closed questions do not enhance the flow of the conversation and can give a detached effect to a worker–client interaction.
In contrast, open questions allow the client to describe their feelings about a particular topic and give you greater insight into the client’s attitudes or views about their situation, e.g. ‘How do you manage living on Centrelink payments alone?’, ‘How does that make you feel?’
Asking the right questions in the right manner
In order to gather information, you need to be an excellent listener and must have good questioning techniques. Nobody likes to be interrogated, and vulnerable clients often already feel disempowered by needing to seek help in the first place.
However, skillful questioning can be a very effective therapeutic tool which assists clients to explore their own feelings and look at the issues from a different perspective.
Keep your questions short. Do not ask two questions at once. Give the client time to clarify or answer the question. Keep your questions relevant and associated with the information the person is giving you.
Formulas for asking questions
This is a very useful technique for interviewing a group of family members or young people. It usually involves asking one member of the group to comment on the relationship or behaviour of the other members.
This type of questioning:
- provides new information
- links one person to another
- shows how people relate
- highlights differences between people and their perception.
For example: ‘Who do you think is closer to your father, your sister or your brother?’ or ‘When your mother tries to get Andrew to go to school, what does your grandmother do?’
The Five WH method uses questions commencing with:
Who? … What? … Where? … Why? … How?
‘Who could help?’
‘What is the problem?’ or ‘What do you think might have happened if ….’
‘Where are you staying at the moment?’
‘Why do you think that happened?’ (Be careful using ‘why’ questions because it can be confronting to clients and put them on the defensive.)
‘How are you feeling about it right now?’
‘What if …’ questions can bring out important themes to consider, e.g. ‘What if your mother decided to leave your father, who would she take with her?’
This questioning tool asks the person to describe what they consider to be ‘the ideal’ situation. For example, ‘What do you consider to be the ideal family?’
‘If you could change the situation to make it right or better, what would you do?’
‘If you could change one thing about yourself (or someone else – name the particular person), what would it be?’
Observe behaviour during the interview
If it is appropriate, and your agency allows for two workers to conduct an interview, it can be good practice to have one worker asking all the questions and the other observing the person’s responses. However, whether there are one or two people conducting the interview, noting down observations of the person’s responses to questions beyond the words they have said may help in assessment of the situation.
Some questions you ask may receive a different response than others. You may need to reword or rework a question so that the person is clear about what you are asking.
Some things to observe and note are:
- emotional state (crying, hysterical, angry, aggressive, distressed, etc.)
- demeanour/manner (withdrawn, sullen, laughing inappropriately, covering up, etc.)
- mood changes (when a particular family member is talking or comes into the room)
- responses of family members to each other, particularly the client.
It is important to consider the context in which any worker–client interaction occurs, as the environment or circumstances surrounding this contact can affect the client’s behaviour. For example, if you were visiting a family and the parent insisted the child join the discussion, then the child may be resentful and resistant if he was being torn away from his favourite cartoon or ‘X Box’ game.
Similarly, if you were speaking with an adult client of a disability service about their sexual relationships and the person’s mother or father insisted on joining the conversation, then the client may become very unwilling to answer further questions or make comments.
Hence understanding the context in which the behaviour takes place helps you gain an appreciation of the motivations behind some actions or responses.
The handout below has more information on Cross-Cultural Communication.
Handout 7 - Cross Cultural Communication (Word Document 37KB)
in the “Disability and Mental Health (402)” toolbox
In your experience at work, what factors have made it difficult for you to gather relevant information from clients? Can you outline procedures your agency uses to overcome these difficulties?
- Lack of suitable interview rooms to ensure privacy.
- Frequent interruptions to the interview by other staff, clients or phone calls, etc.
- Language difficulties, due to either ethnic background of client or specific communication disability, e.g. hearing or speech loss.
- Misunderstanding about the reasons for the questions and consequently lack of trust about the use of the information gathered.
Add these factors and procedures to your Logbook.