It has long been presumed that clinical assessments are performed by psychiatrists, psychologists, and social workers, and that it is not within a counselor’s realm to provide them. Although this presumption has become less universal in recent years, we still do not see many counselors providing clinical mental health assessments. Maybe it is because counselors do not know they can work in that environment or it may be because many counselors feel that they should be doing therapy. My aim is to offer information about clinical assessments in the hospital setting from the perspective of a fellow counselor.
An assessor is typically the first point of contact that a patient sees when entering a psychiatric hospital, and an assessor ultimately provides a level of care treatment recommendation. Treatment recommendations can range from inpatient care to a partial hospitalization program or outpatient treatment. Assessments typically take 1-2 hours, and it includes meeting with the patient and family members, consulting with the patient’s referring physician or therapist (if they have one), and ultimately consulting with a psychiatrist at the hospital. If a patient is recommended to be admitted inpatient, then appropriate sign-in procedures follow. If a patient is recommended to an outpatient program or partial hospitalization, the patient is then informed of the program details.
The assessor is responsible for making sure the patient is able to contract for safety. Often, an assessor is petitioning patients who have expressed suicidal or homicidal ideations with intent, who are actively psychotic, or unable to care for themselves. Once a patient is recommended inpatient or outpatient treatment, the assessor then provides clinical information to the insurance company (if the patient has insurance) for pre-authorization.
Although a counselor in this setting is not providing therapy, there is a relationship that must be established between the assessor and patient. I’ve noticed that it can be difficult to gain the rapport that counselors maintain with a repeating client. It is such a delicate situation in that you have only this one session to gain enough information to provide a quality level of care recommendation, and some patients are not so willing to offer information. So how do you provide effective treatment recommendations to those who are not forthright or willing to provide the details of their presenting issues? This is when a counselor’s therapeutic skills are tested. I have observed that patients are much more willing to share their psychological concerns with me when they feel that they are being understood, that what they are saying is valued, and that there is a genuine concern for their well being. Isn’t that the essence of our profession? Most patients that come for a level of care, however, are seeking help, and they offer information about their emotional well being more freely. So, while a counselor in this work environment does not provide counseling, they must still offer empathy and understanding for patients’ unique needs, create an environment that enables patients to communicate openly, and use their clinical background to accurately diagnose and recommend treatment.
Maureen Werrbach is a counselor who works at a hospital and provides clinical assessments in the areas of mental health and substance abuse.