Evaluation of Practice-Case

Assignment 4: Evaluation of Practice-Case Study

Tara Emery

Social Work Department, University of Calgary

SOWK 662 S08 Integrative Seminar

Lateef Habibi

January 12th, 2023

Evaluation of Counselling Interventions

Note that details have been changed to protect the confidentiality of this client. 

It can feel challenging trying to evaluate our work as social workers when there are so many uncontrollable factors. However, by using validated tools regularly and often can help us in understanding how effective our interventions are. In primary care I have found the Patient Health Questionnaire Anxiety-Depression Scale (PHQ and GAD) to be most commonly used. The advantage of this standardized tool is that it has been determined to be a highly reliable validated measurement for depression and anxiety. Additionally regardless of whether anxiety and/ or depression is the primary diagnosis the symptoms are commonly comorbid with other mental health diagnoses (Kroenke et. al., 2016). 

Other advantages for using the GAD, PHQ in primary care is that it is widely understood by other medical professionals. Having a standardized tool allows us to measure our client work with less bias. Also in many clinics like our’s an electronic medical system is used and can regularly prompt clients to complete a GAD, PHQ and graph out changes over time. This tool provides great quantitative data for a social worker to notice mental health changes, and evaluate our client interventions. For my client Sam, I found that interventions that targeted complex trauma seemed to be most effective. Sam was struggling with sleep, obsessive thoughts and behaviours, anxiety and a lack of self compassion. I did find that the GAD and PHQ questionnaire adequately captured many of these symptoms. One difficulty was when Sam was being treated with pharmacological medications and had an adverse reaction. Without qualitative data it would have appeared that my interventions were ineffective during this period as Sam’s GAD and PHQ scores increased dramatically. It is important for us to remember that a GAD and PHQ does not account for system or situational changes outside of our interventions such as grief or finances. 

Fortunately, the PHQ and GAD scores prompted our team to investigate further, finding that the medication she was prescribed was causing increased anxiety and mild symptoms of mania. I believe obtaining qualitative data from our clients is always of primary importance. Asking my clients what has changed since we last met helps to measure the variables that exist outside of our interventions such as recent break-up’s, health, relational and financial changes. Also, qualitative assessment allows us to better understand the effectiveness of interventions more fully. For Sam at the beginning of our sessions I would check in and ask about our recent session, had there been any new awareness, development or changes. Additionally, writing a case study prompted me to review all the interventions Sam and I tried together allowing us to talk about what was most effective and what was not. This review of our work together was so valuable in increasing safety, Sam didn’t have to say she didn’t like a particular intervention or session instead she was able to say what worked best for her. 

Having professional supervision (feedback from Lateef) was also so valuable in providing new insights, outside perspective and ideas. Additionally in my primary care team we meet regularly to discuss client care, for Sam this helped us in understanding the changes in her PHQ, GAD and shed light on the qualitative information. It is also important that a GAD, PHQ not be used as a diagnostic tool or in isolation as it does not capture all individuals or all mental health symptoms (Eack et. al., 2006).

Social Justice Considerations

When using validated tools such as the GAD and PHQ it is important to keep in mind that much research is conducted in North America and Europe with individuals identifying as caucasian. Sam did identify as caucasian, however as a female we know research has often been male focused so this is also an important consideration. With this research focus it can mean that many cultural or gender differences are unaccounted for. As social workers when we are trying to identify what is normal or healthy we should understand that this will vary from culture to culture or even within genders making it that much more important that our assessments should be client centered, meaning the individual decides what is healthy or normal for them.

References 

Kroenke, K., Wu, J., Yu, Z., Bair, M. J., Kean, J., Stump, T., & Monahan, P. O. (2016). Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials. Psychosomatic medicine, 78(6), 716–727. https://doi.org/10.1097/PSY.0000000000000322

Eack, S. M., Greeno, C. G., & Lee, B. J. (2006). Limitations of the Patient Health Questionnaire in Identifying Anxiety and Depression: Many Cases Are Undetected. Research on social work practice, 16(6), 625–631. https://doi.org/10.1177/1049731506291582

Appendix

Patient Health Questionnaire and General Anxiety Disorder (PHQ-9 and GAD-7) Date_______________ Patient Name:________________________________ Date of Birth: ______________ 

Over the last 2 weeks, how often have you been bothered by any of the following problems? Please circle your answers. 

PHQ-9 

Not at all Several days More than half the days Nearly every day 

1. Little interest or pleasure in doing things. 0 1 2 3 2. 
2. Feeling down, depressed, or hopeless. 0 1 2 3 3. 
3. Trouble falling or staying asleep, or sleeping too much. 0 1 2 3 4. 
4. Feeling tired or having little energy. 0 1 2 3 5. 
5. Poor appetite or overeating. 0 1 2 3 6. 
6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down. 0 1 2 3 7. 
7. Trouble concentrating on things, such as reading the newspaper or watching television. 0 1 2 3 8. 
8. Moving or speaking so slowly that other people could have noticed. Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual. 

0 1 2 3 9. 

9. Thoughts that you would be better off dead, or of hurting yourself in some way. 0 1 2 3 

Add the score for each column Total Score (add your column scores): ______________ 

If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?

(Circle one) Not difficult at all Somewhat difficult Very Difficult Extremely Difficult 

Over the last 2 weeks, how often have you been bothered by any of the following problems? Please circle your answers.

 GAD-7 

Not at all sure Several days Over half the days Nearly every day 

1. Feeling nervous, anxious, or on edge. 0 1 2 3 2. 
2. Not being able to stop or control worrying. 0 1 2 3 3. 
3. Worrying too much about different things. 0 1 2 3 4. 
4. Trouble relaxing. 0 1 2 3 5. 
5. Being so restless that it’s hard to sit still. 0 1 2 3 6. 
6. Becoming easily annoyed or irritable. 0 1 2 3 7.
7. Feeling afraid as if something awful might happen. 0 1 2 3 

Add the score for each column Total Score (add your column scores): ______________ 

If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people? 

(Circle one) Not difficult at all Somewhat difficult Very Difficult Extremely Difficult 

UHS Rev 4/2020 Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.