Evaluation: the initial step in any psychosocial rehabilitation process

At the start of any psychosocial rehabilitation treatment, an initial assessment or evaluation allows individuals to identify their abilities and challenges. This involves assessing their cognitive processes, day-to-day life activity and functioning and their level of autonomy.

How does this evaluation phase work? What tools are used? What are the objectives?

All the explanations concerning this initial phase can be found below and are relevant to all rehabilitation pathways.

The main principles of evaluation in psychosocial rehabilitation

The assessment phase is a crucial preliminary step in any psychosocial rehabilitation process. It makes it possible to highlight the person’s strengths, challenges and their primary and secondary objectives.

The evaluation is multidisciplinary with different professionals involved in the process, including psychiatrists, neuropsychologists, psychologists, nurses, integration officers, occupational therapists, etc.

The evaluation process is made up of at least three assessments:

• a medical interview
• a neuropsychological assessment
• an evaluation of the person’s general functioning abilities

Other assessments can also be proposed according to the service-users’ needs and the breadth of services available. For example, social cognition assessment, occupational therapy assessment, psychomotricity assessment, speech therapy, etc.

After the various assessments are completed, a meeting is held to summarise the results and an individualised recovery plan is constructed based on this feedback.

An overview of the three core evaluations

1. The medical interview

The assessment process always begins with an initial one-hour interview with a psychiatrist. The objectives of this interview are:

• To analyse the request, the needs, and the context:
  o Why does the service-user wish to start a rehabilitation treatment?
  o What is their goal and what are the difficulties they encounter in achieving it?
  o What is his or her care pathway?
• To evaluate the possible presence of cognitive difficulties. ;
• To establish the person’s feelings and motivation with regards to starting rehabilitative treatment
  o Is the person ready to engage in a rehabilitation process?
  o Does it correspond to his or her needs?

At the end of this medical interview, if the person has indicated that psychosocial rehabilitation would be a positive and appropriate next step for them, the psychiatrist will arrange a complementary multidisciplinary evaluation, incorporating the various assessments detailed below.

2. Neuropsychological assessment

The neuropsychological assessment is carried out with a neuropsychologist and usually takes about 2h30. The objective is to draw up a profile of the person’s cognitive abilities and challenges, i.e. to see the impact of the psychological illness on the person’s cognitive functioning:

• In terms of attention, concentration, memory, reasoning (neurocognitive functions);
• In terms of language, communication, visio-spatial functions (cognitive functions).
• In terms of social skills, i.e. forging relationships with others (social cognition).

It ensures that the person’s goals (social, professional, educational or independence plans) are compatible with his or her "cognitive" background. For example, strong memory and recall capacities are conducive to undertaking training or education programmes (because lots of information will have to be retained).

It also makes it possible, if appropriate, to draw up a "cognitive remediation" programme plan, which is designed to reduce any challenges the person may be experiencing and encourage them to achieve their goals.

3. Functional assessment or assessment of daily life

The assessment of day-to-day life or functional skills is conducted by a health professional trained in evaluation tools. This might be a nurse, occupational therapist, psychologist, etc.

It takes place over a period of 2 hours and aims to evaluate the strengths, challenges and objectives of the person in his or her daily life: the areas where they are satisfied with their functional skills, the areas where they have difficulties and the changes they would like to make.

The following areas are discussed:
1. place of living
2. activities/ hobbies
3. social life/ relationships
4. lifestyle
5. travel
6. money management
7. knowledge and management of symptoms
8. specific skills/ goals

The assessment can be supplemented by an "in-situ" assessment in the person’s home and usually consists of a semi-structured interview and potential role-playing situations.

Summary of the results of the assessments and the construction of the individualised care plan

The assessment is presented to the person during a summary meeting, involving the professionals who took part in the assessments, and the person’s family and friends if they so wish. The referral team is also invited to participate. There would be discussion around any difficulties that may arise during rehabilitative care, but above all, there would be a focus on the person’s strengths and abilities in view of mapping out an empowering rehabilitative care plan.

The personalised recovery plan is constructed on the basis of these assessments, which sets out the objectives of rehabilitative care (current situation and objectives), and the support that is proposed to achieve them. This is all formalised in an individualised care plan.

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