Abstract
This chapter discusses the standardization of instruments and typologies in social work assessment and introduces, from a multidimensional perspective, a new standardized instrument evaluating the level of complexity associated with the social intervention process in a sample of chronic kidney disease (CKD) patients. The authors evaluated the matrix's metric properties by internal consistency and defined a rating index through the best cutoff points, using receiver operator curve and Youden Index. Matrix construction and validation used focus groups of experts in blinded classification of 100 CKD patients and indicator weighting. The matrix shows good internal consistency and reliability (Cronbach's alpha = .742). Cutoff points indicate three levels of complexity classification. The matrix is a good instrument to identify the complexity associated with the social intervention process in the area of Nephrology, and is a relevant contribution to the social information management of social workers, the health teams and the administration of health units.
TopIntroduction
The computerization of social assessment in the context of health organizations poses enormous challenges. The complexity of patients' social situations rarely emerges from linear and fragmented statistics derived from records based on isolated variables. Understanding Social Work’s intervention process, the actions it entails and the time involved are often difficult to justify to management departments because they arise from a complex set of interlocking factors that are difficult to quantify. In close complementarity with the clinical diagnosis and prognosis, the social diagnosis must be expressed through methods that recognize this complexity.
In a society dominated by technology, the pressure to record social information related to the processes of study, diagnosis, planning and social intervention has increased sharply to quantify this information, as well as the evaluation of professionals’ workloads. Scientificity, instrumental rationality and technicality cannot, however, overshadow the values of the profession and its humanistic realm, under penalty of realizing the risks of de-professionalization associated with fragmentation and over-bureaucratization emphasized by managerialism and social technology (Amaro, 2014). Despite of the McDonaldization of the social care and care management in Social Work, the “adherence to professional values, supported by professional registration, and an awareness of power, both instrumental and normative, can promote good practice” (Dustin, 2007, p. 164). Opting for a scientific-humanist profile, Amaro (2012) mentions that the instruments are defined and mobilized based on the analysis of a given situation, requiring a reflexive and critical position about them. Bureaucratic and standardized procedures should integrate professional reflexivity and emerge not as ends in themselves, but as methodological strategies to achieve professional goals. These can be evidence of the relevance of a particular social problem, and support intervention programs or institutional policy measures, or even, social policy favoring the well-being of a given population, for example.
Although standardization and categorization emerge as serious trends in the health field, Social Work has been resisting this tendency in his social evaluation procedures, avoiding reductionist and linear evaluations. However, the challenges of computerizing social information require innovation and overcoming such gaps with the construction of standardized multidimensional instruments that could support non-linear social diagnostics and guide intervention plans.
In this chapter the authors debate the controversial approaches to standardization and the potentialities and risks of the use of classificatory typologies in social diagnosis, presenting an innovative assessment tool, in the field of nephrological Social Work, that overcomes some of the identified risks.
Thus, this chapter shows the development and validation of a new standardized instrument that evaluates the level of complexity associated with the social intervention process in a sample of chronic kidney disease (CKD) patients. The matrix presented (MCAPIS_DRC1) aims to identify and classify the complexity associated with the social intervention process with CKD patients, in three levels of complexity, making a relevant contribution to the work of social workers in this intervention area, as well as to the management of health services. This study intends to show the process of constructing an index to be used by social workers in professional evaluation and research in the specific scope of work with a population with a clinical diagnosis of chronic kidney disease and patients undergoing hemodialysis.
Key Terms in this Chapter
Complexity: A property of systems that emerges from the interaction between its parts or dimensions. The more dimensions and more intersystemic interactions, the greater the complexity.
Systemic Puzzle of Disease: Refers to the dynamic interaction between the different impacts and interferences on a personal, interpersonal and family level, such as the idiosyncrasies of disease, the diagnosis, the prognosis, its evolution, the care plan, the demands of the treatments, the associated limitations or eventual disability that occur, as well as the relationship with the health care system and other social services, the rights and access to health care, and the social policies.
Multidimensional Assessment: It is a type of evaluation that articulates different dimensions or different constructs with theoretical coherence.
Standardized Instrument: An evaluation or measurement instrument that is valid and reliable, replicable, without changes or adaptations in its structure and content, in different populations with similar characteristics.
Typologies in Social Diagnosis: Concepts and constructs that constitute references and analytical resources to typify and classify the synthesis of social evaluation. They must be built based on the theory, evidence, values and reflection, through the debate in the profession as a collective.
Social Evaluation: Phase of the social intervention process that implies the study, analysis and synthesis of information of a given problem-situation in context, which aims to determine the nature and magnitude of social needs, strengths and problems. Methodologically, this is a continuous and reflexive applied research that supports the intervention plan. It is a cornerstone of the Social Work profession, designating also for social assessment and social diagnosis.
Nephrology Social Work: Field of the Social Work profession focused on the specificity of psychosocial characteristics and social rights of the population with chronic kidney disease, working with patients and families in the different disease stages and life cycle.