Assessment in an EAP Setting: By More Thoroughly Assessing Presenting Problems and Linking Clients with Appropriate Resources, EA Professionals Can Greatly Improve Treatment Outcomes and Help Demonstrate Their Value to Work Organizations
Warley, Raquel, The Journal of Employee Assistance
Employee assistance programs (EAP) operate to enhance the development and well-being of people as employees. Service objectives in this arena are accomplished through the EAP Core Technology, which includes assessment and referral.
In recent years, a host of factors have led to technological simplification and service fragmentation in EAP settings, and simplified assessment technologies have become fait accompli. The clinical process of determining the nature, cause, progression, and prognosis of the problems for which help is sought has become abbreviated at best and cursory at worst.
The thought of physicians performing medical treatment without engaging in an earnest effort to determine the nature or presence of disease or abnormality is frightening. In employee assistance and mental health arenas, however, professionals are often expected to intervene with clients in the absence of thorough evaluation. This has not always been the case--managed care requirements and resource deficits have moved the field toward rapid assessments and reliance on general and vague terms to characterize the mental, emotional, and behavioral processes of clients. In a climate of greater accountability for treatment efficacy, this is conspicuously ironic.
This article presents a proposal for a promising assessment practice in an EAP setting. The first part of the proposal includes an overview of assessment systems in clinical practice, followed by a discussion of practical implications for culturally sensitive diagnoses. The final section offers a promising model of assessment and research methodology.
In clinical practice it is understood that gathering information about clients and their presenting problems is a prerequisite to service provision (Shear et al. 2000; Franklin and Jordan 1992; Mattaini and Kirk 1991). Clinicians embark upon the arduous task of intrapsychic repair only after obtaining an overall understanding and appreciation of the complexity of a client and his/her situation. There is not, however, a grand assessment protocol (Clair and Prendergast 1994; Thomas et al. 1993), and little consensus exists regarding proper assessment practice.
Although most clinicians are trained in qualitative assessment practices (Shear et al. 2000), many are encouraged to use assessment methods grounded in empiricism. These appraisals quantify various aspects of clients' functioning. Because clinical impressions are not required, these assessments are assumed to be superior to subjective models at deriving reliable psychodiagnoses (Korchin and Schuldberg 1981; Basco et al. 2000; Franklin and Jordan 1995; Springer, Abell, and Nugent 2002; Shear et al. 2000; Kaplan and Sadock 1998).
Clinicians invariably use instruments with psychometric properties to identify treatment needs and monitor the outcome of interventions. Currently, the most popular scales for tapping into psychological and interpersonal functioning are the Rapid Assessment Inventory (RAI), the Minnesota Multiphasic Personality Inventory (MMPI), the Millon Clinical Multiaxial Inventory (MCMI), the Structured Clinical Interview for DSM (SCID), the Butcher Treatment Planning Inventory (BTPI), and the Quality of Life Inventory (QOLI).
Objective measures alone cannot provide practitioners with complete clinical pictures (Shear et al. 2000). Open-ended interviewing is indicated for accessing idiosyncratic meaning systems, schemas, values, motivations, and cultural realities. Listening and probing can uncover full psychosocial histories. Inasmuch as this is true, clinical interviewing is an imperative assessment practice (Franklin and Jordan 1995; Strickland 1994; Thomas et al. 1993).
APPRECIATING CULTURAL DIVERSITY
In pluralistic societies, competent clinicians must appreciate cultural diversity It is not enough to be aware of the many distinct groups within a society; professionals must be adept at incorporating the values, experiences, and needs of the various groups into practice. …