C.A.R.E.: A model for improving the process of assessment

Year 2019, , 13 - 20, 31.07.2019

Sara J. Englısh Andrew J. Flaherty

https://doi.org/10.5505/jaltc.2019.37039

Abstract

Assumptions, perceptions, and expectations (APEs) determine how individuals view the social world and the people who live within. This is especially true if persons do not share the same cultural experiences or beliefs of other individuals. Health care workers serve a variety of individuals from a multitude of cultural and ethnic backgrounds. Although workers are charged with developing individualized plans of care to address the multiple disadvantages and unique needs experienced by persons who admit for healthcare service, APEs held by the worker moderate the clustering of disadvantage experienced by clients within the social environment, further separating them from those who make determinations of, and decisions about, care. Although factors connected to vulnerability or disadvantage may affect the well-being and outcomes of clients, the process of othering, either implicit or explicit, creates and maintains a state of inequity, documented through assessments, care plans, and other formal artifacts of service. This paper uses a critical lens to review how APEs intersect with the existing processes and procedures of assessment, affirming and enhancing clusterings of disadvantage and social injustices experienced by clients, creating corrosive and reified states of chronic disadvantage that lead to poor and pervasive patterns of outcomes for vulnerable persons relegated to the category of the other and proposes a model of C.A.R.E. to improve outcomes during the assessment process.

Keywords

Admission process, APEs, assumptions, disadvantage, expectations, othering, perceptions, stigma, long-term care

References

• Banaji, M. R., & Greenwald, A. G. (2013). Blindspot: Hidden biases of good people. New York, NY: Delacorte Press. [Kindle version]. Retrieved from Amazon.com
• CDC [Centers for Disease Control and Prevention] (2016). Well-being concepts. Retrieved from https:// www.cdc.gov/hrqol/wellbeing.htm
• Freire, P. (1968/1970). Pedagogy of the oppressed. IM, B. Ramos, Trans.). New York, NY: Continuum. (Original work published 1968).
• Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. New York, NY: Simon & Schuster, Inc.
• Grey, F. (2016). Benevolent othering: Speaking positively about mental health service users. Philosophy, Psychiatry & Psychology, 23, 3–4, 241.
• Hatzenbueler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813-821.
• IFSW [International Federation of Social Workers] (2016). The role of social work in social protection systems: The universal right to social protection. Retrieved from https://www.ifsw.org/the-role-of-social-work-in-social-protection-systems-the-universal-right-to-social-protection/
• Johnson, J. L., Bottorff, J. L., Browne, A. J., Grewal, S., Hilton, B. A., & Clarke, H. (2004). Othering and being othered in the context of health care services. Health Communication, 16(2), 255-271.
• Kosar, C. M., Thomas, K. S., Inouye, S. K., & Mor, V. (2017). Delirium during post-acute nursing home admission and risk for adverse outcomes. Journal of the American Geriatrics Society, 65(7), 1470-1475.
• NASW [National Association of Social Workers] (2017). Code of ethics. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of- Ethics-English
• Perlman, H. H. (1979). Relationship: The heart of helping people. Chicago, IL: University of Chicago Press. Powell, J. A., & Menendian, S. (Jun 29, 2017). The problem of othering: Towards inclusiveness and belonging. Retrieved from http://www.otheringandbe- longing.org/the-problem-of-othering/
• Prasad, P. (2018). Crafting qualitative research: Beyond positivist traditions (2nd ed.). New York, NY: Routledge.
• Richmond, M. (1917) Social diagnosis. New York, NY: Russell Sage Foundation. Retrieved from https:// archive.org/stream/socialdiagnosis00richiala/socialdiagnosis00richiala_djvu.txt
• Sakamoto, I., & Pitner, R. O. (2005). Use of critical consciousness in anti-oppressive social work practice: Disentangling power dynamics at personal and structural levels. British Journal of Social Work, 35, 435-452.
• Schrauger, J. S., & Osberg, T. M. (1981). The relative accuracy of self-predictions and judgements by others in psychological assessment. Psychological Bulletin, 90(2), 322- 351.
• SAMHSA [Substance Abuse and Mental Health Services Administration] (2009). Screening and assessment. In Substance Abuse and Mental Health Services Administration (Ed.), Substance abuse treatment: Addressing the specific needs of women. Rockville, MD: SAMHSA.
• Tomberlin, J. P., Eggart, J. S., & Callister, L. (1984). The use of standardized evaluation forms in physical therapy. The Journal of Orthopaedic and Sports Physical Therapy, 5(6), 348-372.
• Toney-Butler, T. J., & Unison-Pace, W. J. (2019). Nursing Admission Assessment and Examination. In Stat- Pearls [Internet]. StatPearls Publishing.
• Tylee, A., Haddad, M., Barley, E., Ashworth, M., Brown, J., Chambers, J.,…Walters, P. (2012). A pilot randomized controlled trial of personalized care for depressed patients with symptomatic coronary heart disease in South London general practices: The UPBEAT-UK RCT protocol and recruitment. BMC Psychiatry, 12(1), 58-66.
• VIU [Vancouver Island University] (2018). The role of assumptions, perceptions and expectations in Conflict. Retrieved from https://adm.viu.ca/workplace-conflict/assumptions-perceptions- expectations
• Werner, S., & Araten-Bergman, A. (2017). Social workers’ stigmatic perceptions of individuals with disabilities: A focus on three disabilities. Journal of Mental Health Research in Intellectual Disabilities, 10(2), 93-107.
• Wolff, J., & de-Shalit, A. (2007). Disadvantage. New York, NY: Oxford University Press.
• Wright, J., Williams, R., & Wilkinson, J. R. (1998). Development and importance of health needs assessment. British Medical Journal, 316(7140), 1310- 1313.