Self-care and stress management is even more necessary at this time. The pandemic has been with us for over a year and we have all suffered our own levels of stress during this time. I know in my 47 years of working as a counselor and psychologist that I stress myself out over the core function of assessment. Assessments take time. The core function definition for assessment is "Those procedures by which a counselor/program identifies and evaluates an individual’s strengths, weaknesses, problems, and needs for the development of the treatment plan.” There are five Global Criteria for the core function of assessment. Over the years I have learned to streamline the initial evaluation paperwork and developed templates and auto correct options to streamline the report generation process. It takes time to review initial paperwork of a client, administer additional screening/diagnostic tools, do the clinical interview, gather collateral information and then write a comprehensive narrative report. For me, the narrative report is often quite time consuming. Perhaps it is my obsessive nature to make sure that I communicate the client’s diagnostic picture to the reader. The narrative report captures the client and provides the reader with the necessary information to understand the client’s strengths and challenges, problems and needs. The information gathered leads to a diagnostic impression based upon all the available information which includes making a level care determination and recommendations for the client. The completed assessment leads to the development of the treatment plan. The treatment plan determines what I address in my counseling of the client/family.
One area where I reduce my stress and do some important self-care is in the core function of assessment. Since the COVID pandemic hit my clinic, I have had to re-engineer how we bring in new clients and provide the initial assessment. Every client needs to have an assessment in order to diagnose and develop a treatment plan. In the past year and a half, I have partnered with some information technology (IT) experts out of Culver City, California. Together we have formed Herdman Health which is an intuitive software company that provides a cloud-based assessment process and guides the counselor through completing the assessment and then generates a professional looking narrative in Word format ready for finalizing. The form is called the Herdman Assessment Form (HAF) and provides the framework for completing substance-abuse, mental health and co-occurring evaluations. The HAF includes bio-psycho-social history completed by the client and reviewed by the counselor. The HAF allows the counselor to rate and justify the client’s functioning in the ASAM six dimensions along with providing a framework for a clinical diagnosis, summary and rationale, level of care recommendation, and other recommendations for the treatment plan.
In this time of COVID my office sends the client an invitation to complete a client history providing a rationale for this request (Global Criteria #12). The client completes their own history with easy drop-down, bubble choices, or, space for the client’s own words. Once completed I am informed that the client competed the history form. Before the client is seen, either in person or via tele-health, I review the history and take note of discrepancies or items that need further questioning. Global Criteria #13 is where I am asked to “gather relevant history from the client, including but not limited to, alcohol and other drug use using appropriate interview techniques. The HAF is an appropriate interview technique. This process alone saves me approximately 30 minutes of interview time. I used to schedule an hour and a half for that initial substance-abuse clinical interview. Now I only schedule an hour. This half an hour saved allows me to then complete Global Criteria #14 "Identify methods and procedures for obtaining corroborative (collateral) information from significant secondary sources regarding the clients alcohol and other drug abuse and psychosocial history”. The HAF has a tab to allow me to type in the significant information obtained from these collateral sources. Additional tabs in the HAF include a table for completing the ASAM Criteria ratings in the six Dimensions and allows me to justify why I rated the client the way I did. This justification allows the reader to understand why I recommended the level of care that I made. Another tab is for the Diagnosis/Summary/Recommendations. The table provided allows me to make a primary diagnosis using the DSM-5 and then any additional diagnoses that are within my scope of practice. The diagnoses tables are easy to fill in. When I know the DSM-5 code the HAF auto populates the name of the diagnosis; if I start typing the words for the diagnosis, the HAF provides the code.
In the Summary, the HAF populates the reason for referral and who referred the client taken from what the client reported. Then only a trained professional can pull all the information together and provide both the rationale for the diagnosis and the level of care recommendations.
The HAF provides the ability to use a checklist of the usual and customary recommendations that a counselor makes for a client. All the ASAM levels of care are listed. These are then put into the narrative as recommendations with the ability in Word to add additional recommendations.
My clinic has some additional assessment tools we use; your practice likely has others. With the ability to download the narrative into Microsoft Word format, the counselor can then add any additional screening/assessment tool templates and easily add the findings. (Global Criteria #15).
What really stresses me out is preparing the assessment report (Global Criteria #16). Back when I used the Addiction Severity Index (ASI), I used the paper and pencil forms provided for the ASI. Then, I had to type up the client history and the additional clinical information for a comprehensive narrative report. This would take me hours. I would stress myself out because I seemed to be always behind. I would go to the office on a Saturday or Sunday just to write reports. Additional stress came from referral sources (or possibly your supervisor) asking when the report will be done. Now with the HAF, not only do I save about a half hour in the assessment interview, I also save anywhere from 1-2 hours (or more) in report writing time. Once I complete the HAF and add the additional clinical information I click a button to preview the narrative. If the HAF does not allow me to preview I know either the client or myself did not complete an item and then I can make the correction/addition. When I am happy with the previewed narrative, I can download the narrative as a Microsoft Word document. Then I can use my clinic’s letterhead template and edit the report. I can use my additional screening/diagnostic tool templates, add any individualized recommendations, and complete the report. As I said, this saves me hours of time and significantly reduces my stress from being behind in paperwork.
Depending on your work place situation, using the HAF to reduce your stress makes sense. I did not use tele-health before COVID. During the COVID pandemic, my agency had to re-engineer how we brought in new clients; keeping them (and my staff) safe and doing our “due diligence” to keep the quality of our work at a high level. If you are in a private practice setting where you generate “billable income”, using the HAF allows you to schedule (and bill) for additional professional services with the time you save. If you are salaried, like in a clinic or residential treatment program, saving the time in the initial assessment interview and in generating the assessment report allows you to have more time providing client care.
Working to keep my own stress levels manageable and fueling my passion to help other counselors, I keep myself energized and excited to work on improving the assessment process. Very soon HerdmanHealth will be using artificial intelligence (AI) to “suggest” possible recommendations for the counselor to consider based upon how the client answers various questions on the HAF. On the HerdmanHealth roadmap for the near future is taking the assessment to the next core function – treatment planning. I will be quite happy to make the treatment planning process easier for counselors, thus saving time and reducing stress again.
For those of you who are students, in the near future HerdmanHealth will be partnering with the California Consortium of Addiction Professionals and Programs (CCAPP) in providing a training tool that includes the HAF, plus treatment planning and progress note modules. This will be a combined effort for workforce development, not only in California, but throughout the United States.
If you are interested in learning more about the Herdman Assessment Form (HAF) as a way to streamline your assessment process, reducing your stress, please write to me at johnh@herdmanhealth.com.
