If through screening a patient is identified as very likely suffering from a psychotic disorder, a two-hour assessment interview is arranged in collaboration with a case manager who will take primary responsibility for the patient through the patient’s tenure in the program. The psychiatric assessment is completed by a Program Psychiatrist. Each one of five program psychiatrists has at least one assigned time slot per week for such assessments. Families are invited and expected to attend the assessment appointment. The psychiatrist and case manager have well defined roles during the assessment interview.
The psychiatrist conducts a psychiatric consultation with the client while the case manager interviews the family to gather data relevant to the client’s birth history, childhood milestones, trauma, school adjustment and achievement and history of the presenting problem. It is important for the case manager to give each family member an opportunity to give his or her perspective on the client’s problem if this has not been achieved during the screening process. All family members are encouraged to attend this appointment as each member will have a different relationship with the client and a different understanding of the problem. These differences become important in the various stages of illness and its treatment. Families are given the Wisconsin Quality of Life Questionnaire (Family Version) at the end of the first session and asked to return the questionnaire as soon as possible. This allows the family to express their version of the patient’s circumstances and to identify their goals for the patient and themselves.
Some families present with definite illness related questions while others hold other explanations for symptoms and behaviours. Some families deny or minimize the client’s difficulties. It is to be expected that families may resist or reject the help offered, and this is viewed as a normal coping style when dealing with serious illness.
Case managers can ease the burden by attending to whatever family stresses are present, in hopes of alleviating the situation through reassurance and support or by making a referral to an appropriate community service if the stress is unrelated to the primary problem of psychosis. In general, family strengths need to be identified and capitalized upon, especially during the early stage of engagement. It is important for families to assume a role as partners in care. The client, family and interdisciplinary team working in collaboration with one another helps the client attain the highest level of functioning
possible.
The social worker completes the initial family assessment when the client enters PEPP through the inpatient service and provides the necessary support to the family according to the same principles as stated above. In order to facilitate the transfer of care for outpatient follow-up and longer term management, a program case manager, allocated to the newly admitted patient, will liaise closely with the social worker.
For patients assessed as outpatients, the family assessment is conducted by the case manager. The initial assessment concludes with the patient, family, case manager and psychiatrist meeting together to discuss a plan of action.
