May 30,2019

Setting the stage for the assessment (in the patient’s home setting).

When you call to set up the appointment, you can “prep” the client.

Let them know that “I’ll have my ‘lab coat’ on; it’ll be like the doctor making a home visit, asking you very detailed and personal questions.”  “What kind of questions?  Anything from your birth to yesterday, from your best day at school to your worst day ever.  About money, friends, sex, success and sadness.”

• Tell them to have ALL medications on hand.
• A list of current and past doctors, psychiatrists, agencies, therapists with reasons for treatment at the time, dates, results, problems related to the treatment (side effects for medications, bad “fit” for therapy, treatment ended b/c it was ‘successful.’}
• A list they make up of their strengths and assets.
• They should begin to think about and write some notes about “how it all started.”
• And to be prepared for you to “pack in a lot of questions in the time we have scheduled.”

Ask that they set up a quiet place for the two of you to talk.

Ask that – if they have someone living with them, someone who is a support – that person can be there, but you need to do “as much with you alone as I need to – – – and get to talk to anyone who can help.”

Warn them ahead of time “If you are a talker, and 50% of people I see are talkers, I may be interrupting you frequently: I don’t mean any disrespect, I mean to do the best job I can for you; if you are not a talker, sometimes I’ll ask ‘leading questions’ – still no disrespect, still serving you best.”

Seeing a child?  Much the same telephone script with the parent, but always remember to ask permission to speak to the child via telephone.  Break the ice.  Let the child hear your voice.  Ask if the child has a favorite color or TV show or music (depends on age).  Something concrete.  Make note of that.  When you go to the appointment, consider (a) at the very least mention you thought about their favorite color, show, music – ask them to say a little more; (b) wearing something of that color, bringing a toy, humming a few bars of music (even if its not their favorite music – just to ‘say’ (metaphorically) ‘I like music too.’

This co-creates a transitional object between you and the child.  And the asking permission makes the parent an ally (most of the time).  They like being asked for permission.

Seeing a child?  Tell the parent you may want to see the two of them interact and for the parent to think of something that is mutually pleasant for the parent and the child.

Why?  (a) This “seeds” them to focus on ‘solutions’ not problems.  (b) If they experience success, great!  But if there is difficulty with this task?: it gives you a ‘heads up’ micro-assessment that there is some difficulty and either more or less activity is called for on your part.

You can also ask the parent if they are comfortable using their cellphone to audio or video record the child, especially if the concerning behavior is intermittent.

All these are micro-techniques – and mostly extensions of standard ones – for preparing people to be interviewed.  Which is often an embarrassing situation for the patient/family.  So give lots of prep and “prop” (Equation: Support, support, support….confront).