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HANDBOOK
FOR
ASSESSMENT TEAM
Assessment and Referral of Clients
Practice and Policy
Assessment and Referral of Clients
Practice and Policy
July 2017
CONTENTS
Page
Organisation: 3
1. Name of team and meeting
2. Function of team members
3. Composition of team
4. Induction and training for assessment workers
5. Appointment to the team
6. Training 4
7. Frequency of meetings
8. Remuneration
9. Responsibility of assessment team
10. Supervision of assessments
THE ASSESSMENT INTERVIEW, REPORT, REVIEW AND NOTES
Points to be raised at the start of the interview 5
Assessment Report 5
Notes from the Review Meeting 6
SUMMARY OF MAIN POLICIES
Suitability of counselling for clients 7
Referral of clients not accepted at the Assessment Review Meeting 8
CHILDREN AT RISK 8
SUICIDE 9
MEDICAL RELEASE FORM 9
Assessment fees 10
Gender of counsellor 10
Bridging Sessions 10
Allocation Procedure 10
Referral of Clients within the Foundation 10
Clients who have received time-limited counselling 11
Clients remaining on available list for more than 8 weeks 11
Appendix 12
1. Name of team and meeting:
Assessment team, Intake and Assessment review meeting.
2. Function of team members
To assess potential clients according to an agreed procedure, and to make an initial judgement as to the client’s needs and suitability for counselling at the Foundation.
3. Composition of team
● Supervisor – qualified, experienced and skilled in assessing for suitability for psychodynamic counselling. Final decisions regarding client allocation made after discussion with the Clinical Director and Centre Head.
● Clinical Director – Responsible for implementing the decision of the Team.
● Centre Head – responsible for knowledge of availability of counsellors and room
● Assessment interviewers – minimum qualifications Advanced Diploma in Psychodynamic Counselling.
● Students of the Advanced Diploma on placement (see 4 below).
4. Induction and training for Assessment/Intake Workers
Advanced Diploma students are required to do a placement at one of the Centres as part of their module on Assessment. Students observe the team in action and then conduct their own interview at the discretion of the Supervisor/Clinical Director. The trainee will be required to conduct at least two interviews for training purposes. They write their notes and present them at the assessment meeting following each interview. After group discussion the notes are agreed and a final copy is made. A second assessment interview is conducted by the trainee with a second client some weeks later.
When students have completed 2, or more if required, assessments they will be given written confirmation of clinical completion of the module
5. Appointment to the team
The Supervisor is appointed by the Foundation at the discretion of the Clinical Director and Head of Training. The supervisor is responsible to the Senior Supervisor and Clinical Director.
Member of the Intake team apply in writing to the Clinical Director/Head of Centre who will discuss the application with the team and reply formally. They can do this when they have successfully completed the Assessment module or equivalent.
6. Training for Assessment/Intake workers
● Placement and theoretical workshops as part of the Advanced Diploma Course.
● Ongoing discussion, perusal of relevant papers at intervals during the years.
● Occasional team meetings to monitor policies and procedures and discuss relevant documents.
7. Frequency of meetings
Fortnightly for 1.5 or 2 hours. Extra sessions may be arranged if required to meet demand.
8. Remuneration
● Supervisor at current rate according to their employed status.
● Counsellor/Interviewer at current rate per assessment.
● Remuneration should be reviewed annually.
9. Responsibility of the assessment team
Responsibility starts when the potential client has accepted an assessment appointment from the Centre and finishes when the client has started counselling within the Centre. At this point responsibility transfers to the client’s counsellor and the counsellor’s supervisor. The Centre Head has responsibility for monitoring the progress of allocation for the client within the Centre.
Clients returning to the Centre or being returned to the Available Clients List, if less than six months has elapsed, should be brought back to the Assessment Team before counselling is resumed. A client returning to the Centre should normally have an assessment interview if six months or more have elapsed since the last counselling sessions.
10. Supervision of assessments
The main function of the assessment group is to assess the suitability of clients for psychodynamic counselling within the Foundation. However it is also a function of the Assessment Review that the performance of the interviewers is explored and they are assisted in improving their assessment and interviewing skills. This applies to qualified counsellors as well as students.
THE ASSESSMENT INTERVIEW, REPORT, REVIEW AND NOTES
Points to be raised at the start of the interview
1. The reasons for assessment
2. The possibility of more than one interview and reasons why, e.g. more time or information needed, points which require further discussion etc.
3. A report will be written and presented at the Intake meeting.
4. The assessment interviewer explains the following:
a. When the client will hear, - the acceptance letter within 1-2 weeks or alternative suggestions for treatment.
b. Confidentiality – within the Foundation. If known to other clients (e.g. husband and wife) or to another counsellor, the other counsellor concerned will not have access to the material of the client, nor will the counsellor be present at any discussion about the client. A client who is known personally to another client or member of staff will be advised to apply to another the Foundation centre for reasons of confidentiality. Exceptions to confidentiality rules are explained: risk to self or others; danger to self or other; The Children Act 2004 (i.e. disclosure could be made if child at risk); The Terrorism Act 2006 (e.g. an act of terrorism should be disclosed); The Proceeds of Crime Act 2002 (c.29) (POCA) (i.e. disclosure of money being earned as a result of or in connection with an offence).
c. The assessment interviewer will probably not be the client’s future counsellor.
d. Waiting list – if there is one, information is available from the Centre Head.
e. The assessment interviewer should explain that the client will see the same counsellor, in the same place, at the same time weekly for 50 minutes. The sessions will not over-run. They should also explain that ongoing counselling sessions are different from the Assessment – the client sets the agenda not the counsellor and questions will not normally be answered directly etc.
f. The assessment counsellor will discuss fees based on what the client is able to pay, having explained the full cost of a session. The assessment counsellor will also explain that all missed session will need to be paid for, also holidays. However if the counsellor is unable to attend there will be no charge.
Assessment report
The first task is to check if the client is known to any of the team. The assessment report will be headed with the client initials/number, the date and the interviewer’s name. Please refer to the template. (See appendix) During the report the client may be referred to by an initial or as “the client”.
There are two sections (subjective and objective) to the writing of the assessment report. Each section must be kept separate and the subjective part will be shredded when no longer required.
The first section covers:
1. A short summary of life events/history
2. Referral
3. Reasons for seeking counselling and “why now?”
4. Previous treatment for psychological problems
5. Medication past and present
6. Hopes and expectations
7. Suicide
8. CORE
9. Drugs and alcohol
10. Present situation
11. Early life
12. Later life
13. Practical concerns:
a. Medical Release Form signed
b. Fee paid, preliminary discussion of fee for ongoing counselling.
c. Availability for counselling – days, times etc. It should be explained that the more availability the better.
d. Any particular needs (e.g. disability or request for female /male counsellor
Some sections may be combined but all the above headings should be covered.
The second section is the subjective part of the assessment and is on a new sheet of paper covering:
1. First impressions
2. Presentation of the self in the interview
3. A formulation of object relations, transference and counter-transference from the interview
4. Any other psychopathological observations
5. View on suitability for counselling at the Foundation and recommendation of level i.e. first client /Advanced Diploma etc.
These areas may be combined.
This second section will not be kept after allocation to a counsellor and will not be part of the client records.
The Assessment counsellor will have the client pack prepared by the administrator which includes CORE, medical release and client information given.
Notes from the Assessment Review Meeting
The template for the assessment must be followed as this gives all the information required by the Intake team to process the referral. A front sheet is completed regarding each referral with the comments and recommendations of the Intake team, this is added to the client pack with the notes, which is given to the counsellor when he allocation is made.
The notes of main points made at the Review meeting should contain appropriate comments and/recommendations and must be agreed at the review meeting. It may be useful to add information only found by reading all the letters in the file e.g. involvement of mental health workers, social workers; any information from the GP not recorded elsewhere.
SUMMARY OF MAIN POLICIES
Suitability of counselling for clients
1. Whilst the policy of the Foundation is to use psychodynamic theory to underline counselling practice, there are clients who may require long periods of supportive counselling before they are able to use psychodynamic counselling. These clients are regarded as suitable for counselling at the Foundation.
2. Past statistics have shown that clients in general can be put into three main groups –
i. client clearly suitable – most of clients assessed
ii. clients clearly unsuitable – a small minority of clients assessed – including the following –
● Clients currently abusing substances in ways that seriously impair their abilities to use counselling e.g. arriving intoxicated for a session. They may be acceptable after a period of six months from ceasing abuse.
● Clients who are psychotic or heavily dependent on medication to prevent psychosis.
● Clients who are currently abusing children
● Clients who refuse to pay their fees
● Clients who refuse to sign the medical release form. All clients must be registered with a GP.
● Clients whose mental ability makes it difficult for the counsellor to work with them without special training.
● Clients who want to use counselling or the counselling service to support their cases with a court of law – civil or criminal e.g. child custody, insurance claims, to build a defence case.
● Clients who are seen as likely to act out in ways that cannot be held within counselling/talking therapy.
● Clients who have been sent by a third party e.g. wife, GP, Social Worker, but do not wish to come for themselves
● Clients with obsessive-compulsive disorder may be assessed as being more suited for cognitive behavioural therapy.
● Clients clearly showing anti-social personality should not be accepted, by definition they are unlikely to present for counselling but may be included in another category above e.g. to sue counselling for a court case.
● Clients who are a risk to others or themselves:
● Clients who are a high risk of suicide (See TCF 09) or serious self harm – which may include severe eating disorders. High risk Core scores will be taken into account.
● Clients who are at risk of behaving violently
● Clients who are seen as marginally suitable for psychodynamic counselling.
e.g. those with poor ego strength; low psychological mindedness; low ability to symbolise or concrete thinking; unlikely to stay in counselling. Some of these clients may have low incomes and cannot get help elsewhere. The policy is that they should be given the opportunity to experience counselling with agreement from the Assessment team. We are not so confident in our ability to predict outcomes as to be able to refuse clients who come into these categories even if it seems they are unlikely to stay. We should remember that they have been sufficiently motivated to ask for counselling.
In all cases the decision lies with the Assessment Team
3. Referral of clients not accepted at the Assessment Review Meeting:
1. When a client is felt to need a psychiatric assessment, the client is advised to contact their GP and the GP is sent a letter informing them of our recommendation. This is done with the agreement of the client. Whether or not the client acts on this advice is a matter for the client and the GP and the Centre has no further contact.
2. When a client is thought to need psychotherapy or at least twice weekly therapy this is discussed face to face with the client who is then offered a list of local therapists. The list is alphabetical and based on UKCP and BACP registers.
3. In exceptional circumstances the client may be referred to a named therapist e.g. a trainee psychotherapist in a recognised analytic or analytical training who can offer low cost “slots”. This can be seen as social responsibility.
If a client considers that the Centre waiting time is unacceptable, they are offered the list of therapists.
CHILDREN AT RISK
1. Refer to the Counselling Foundation policy TCF 06
2. If there appears to be immediate risk to children of sexual or physical abuse, the Assessment interviewer should contact the Clinical Director or Centre Head immediately. The Clinical Director will follow the procedures as laid out in TCF 10. This should be recorded and the report added to the Risk register held by the Clinical Director.
3. As a matter of course the client is informed of the Foundation Policy on Safeguarding i.e. that confidentiality is withheld and that the situation will be discussed further with management.
4. If the client declines counselling after revealing child abuse, the matter must be reported to the Clinical Director.
SUICIDE
1. The policy pertaining to suicide TCF 09 must be followed
2. The Client’s state of mind and previous attempts must be recorded in the Assessment report.
3. Action must be taken by the Assessment interviewer in the case of a client indicating suicidal intentions -
● Mild risk i.e. no definite plans – record and present at review meeting.
● Moderate risk – client is thinking of suicide and has plans – present at review meeting.
● Severe/active risk – as in the case of moderate risk but also contact the Clinical Director/Centre Head immediately.
● For all suicide risks above mild, discuss with the clients if they would take such action as contact Samaritans on 116 123 or refer themselves to the local hospital A & E department if the desire to kill themselves becomes overwhelming. Out of hours mental health helpline number can be given – 01438 843322
Signing the Medical Release Form (MRF)
All clients who present for assessment are asked to sign the MRF. Reluctance or refusal to sign should be used as material for investigation of the underlying anxieties. The Centre policy is that the MRF must be signed. The client should be told of the policy and told that it will be discussed at the Assessment Review.
Assessment fees
An assessment is not organised until the Centre has received a deposit of £20/40. It is not refundable. If the client feels unable to pay the deposit and requests a refund this should be referred to the Office Administrator.
Clients unable to meet the full cost of the assessment may pay the reduced fee. MOST CLIENTS SHOULD BE EXPECTED TO PAY THE FULL AMOUNT. All discussions about fees should be regarded as part of the psychodynamic process and recorded and discussed at the Assessment Review.
Gender of Counsellor
There are sometimes requests for particular types of counsellor, these can include –homosexual, not student, Christian etc. If this occurs the interviewer should indicate that such referring is not part of the Foundation policy. There may be an exception made in the case of gender male/female, or occasionally age of the counsellor. In all cases the request should be examined psychodynamically. The interviewer might bring to the client’s notice that there are counsellors of both genders at the Centre, at the same time as the client is told that the interviewer is unlikely to be the ongoing counsellor. The material raised may then be used to discuss the question of counsellor gender later in the interview.
Bridging Sessions
Bridging (holding) sessions should not be discussed at the interview. The decision to offer them lies with the Assessment team and is based on the need of the client as assessed. If bridging sessions are held it is preferable that they should be conducted by the original interviewer unless that person is no longer available or the assessment team decides that this should not be the case. The interviewer must inform the assessment team of a bridging session. The bridging session should be written up and presented at a Review meeting.
Allocation Procedure
Clients are allocated to suitable counsellors as soon as possible following the decision made by the intake team. Allocation is decided between at least two members, preferably three, of the team – however the team deciding whether a client is suitable for our service must include the assessment supervisor and Clinical Director/Centre Head. This decision cannot be over-ruled by assessment counsellors if there are clinical concerns – assessment supervisors are qualified to make the decision as to whether the client is suitable for our service. However if there are concerns, the Clinical Director who holds overall clinical responsibility may seek advice via supervision, and if necessary a psychiatrist (TCF 10) then report back to the assessment team. In the absence of the Clinical Director, the supervisor will consult with the Clinical Director before the client is accepted to the Service. The final decision about a client being counselled by a particular counsellor always lies with the counsellor’s supervisor.
Clients who have received time-limited counselling at the Foundation
If a client is referred to the Centre for open-ended counselling by a counsellor who has been seeing the client for time-limited work, either as part of an IAPT/NHS Counselling Contract or any other short-term contract, they will normally go through the procedure for new Centre clients. This includes contacting the office Administrator and being assessed. The previous time-limited counsellor should not be involved in this process. However, the client may give written permission for this counsellor’s assessment to be passed to the Assessment team.
There may be exceptional cases where the client’s best interest is to continue in counselling with the time-limited counsellor if that counsellor has a space and is willing to take them on again. This can only happen after full discussion with the Assessment Team and agreement by the Clinical Director and the counsellor’s own supervisor.
There is a recommended waiting time of a minimum of four weeks before a client can be offered an assessment after the end of the time-limited contract.
Clients remaining on the “Clients available list” for more than eight weeks.
It is the responsibility of the Clinical Director/Centre Head to note clients who are not being taken up by a counsellor and to contact them where appropriate. The Clinical Director may choose to act independently, but there may be a case for bringing the client to the Assessment Review meeting for further discussion.
APPENDIX
The followed policies must be adhered to during the assessment process:
TCF 06 Intake Assessment and Allocation Process for New Clients
TCF 09 Suicide Threat or Actuality
TCF 10 Immediate Risk and Out of Hours Procedure
Initials: No: Date: Interviewer:
Enquiry date: Age: Gender:
Marital status: Living arrangements:
Employment: Children:
Referred by:
Medication: Psychiatric involvement:
CORE score:
Availability:
_________________________________________________________________
Comments/Frame Issues
Presenting problem
Current situation
History
This section is for Supervision and training purposes only.
Do not keep – to be shredded by allocated counsellor once client has been accepted.
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Reg No: Intake date: Intake counsellor:
Comments/ Frame Issues
Presenting Problem
Psychodynamic Profile/Transference & Counter Transference
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