An ANOTHER MENTAL HEALTH ASSESSMENT MEASURE
By: SOPHIA F. DZIEGIELEWSKI
Social workers
believe strongly in design and base
all practice strategy on
the recognition of the person in the environment or person in the situation
(Colby &
Dziegielewski, 2010; Dziegielewski, 2013). From this perspective, the individual is
believed to be part of
the social environment, and his or her actions cannot be separated from
this system. The
individual is influenced by environmental factors in a reciprocal
manner.
Impetus toward
the development of this
perspective may be
partially related to dissatisfaction with the reliance on psychiatric-based
typologies, which failed to account for environmental influences. The categorical approaches within the DSM did not appear to give such influences proper attention.
Because these existing categories did
not involve psychosocial situations or units larger than the individual
within a system,
problems were not viewed from an environmental context, thereby increasing the
probability of such
problems being classified as a
mental illness (Braun
& Cox, 2005). In such a system,mental health practitioners could diagnose
an individual with a
mental health condition due to some general medical or symptom-based concern but
were given no leeway to address a mental health condition based on life events and/or
situational factors.
What transpired
with the dynamic changes
starting in the DSM-III encouraged social workers and
other mental health professionals to provide
aggregate parts to a diagnostic classification system. This focus on
the individual tended
to minimize the
psychological and social causation, focusing more strongly on the reductive
and biological
causations of the disorders, hence its specific focus on symptom-based typologies (Brendel, 2001). Clear demarcation of symptom-based
criteria for diagnosing and classification encouraged by insurance companies became an efficient and cost-effective measure for the treatment of mental disorders. Because insurance
companies required a
medical diagnosis before service reimbursement, social workers, psychologists,
and other mental health professionals waged a long and difficult fight to use DSM independently for third-party
payment purposes and their distinct services.
Originally
developed through an award
given to the California
chapter of the National Association of Social
Workers (NASW) from the NASW Program Advancement Fund (Whiting, 1996), a system was designed
to focus on psychosocial aspects, situations, and units larger than
the individual. It was
called the Person-in-Environment Classification System, or PIE (Karls
& Wandrei, 1996a, 1996b). It is
built around two major
premises: recognition of social considerations and the person-in environment
stance— the cornerstone on which all social work practice rests. Knowledge of the PIE is relevant for
all mental health social
workers regardless of educational level because of its emphasis on
situational factors (Karls & O’Keefe, 2008, 2009).
The PIE system
calls first for a social work assessment that is translated into a description of coding of the client’s problems in social
functioning. Social functioning is the client’s ability to accomplish the
activities necessary for daily living (e.g., obtaining food, shelter, and
transportation) and fulfill major social roles as required by the client’s subculture or community (Karls & Wandrei, 1996a, p. vi).
Originally
designed to support the use of the
DSM-IV rather than as a substitute for
it, the PIE’s purpose was to evaluate the
social environment and to influence the revisions of the DSM.
Essentially, the
PIE provided social workers and
social work educators
with a tool that allowed environmental factors to be considered of primary importance.
The PIE, an environmentally sensitive tool, supplemented the descriptive system of
the DSM
that
related the mental illness to
the human condition,
utilizing a holistic, ecological, and pluralistic approach rather than just
the diagnosis-focused (medical)
foundational basis
of the DSM
(Satterly,
2007).
Social workers
proposed an ecosystems perspective incorporating the assumption that clinical practice needs to include the individual within
his or her social environment and that his or her actions cannot be separated from his or
her support system.
Therefore, the PIE adopted features of the DSM-IV and DSM-IV-TR multi-axial diagnostic system
in its assessment typology and had a notable influence on DSM revisions, particularly in the
area of recognizing environmental problems. One
concrete example of
the PIE’s influence on the DSM-IV is the change of Axis IV of the diagnostic system to
reflect “psychosocial and environmental
problems” where the problem is clearly
listed; in the past the DSM-III-R Axis IV merely listed the “severity of psychosocial stressors” and ranked the problem on a scale. Although the multiaxial
system has been deleted
in DSM-5, Chapter 22 lists “Other Conditions That May Be a Focus of Clinical Attention,” which continue to be used.
The PIE was
formulated in response to the
need to identify client
problems in a way that health professionals
could easily understand (Karls & Wandrei, 1996a, 1996b).
As a form of classification system for adults, the PIE provides:
■ A common language with which social workers in all settings can describe their
clients’ problems in social
functioning.
■ A common capsule description of social phenomena that can facilitate treatment or ameliorate problems presented by clients.
■ A basis for gathering data to be used to measure the need for services and to design human service programs to evaluate effectiveness.
■ A mechanism for clearer communication among social work practitioners and between practitioners, administrators, and researchers.
■ A basis for clarifying the domain of social work in human service fields (Karls &Wandrei, 1996a).
■ A common capsule description of social phenomena that can facilitate treatment or ameliorate problems presented by clients.
■ A basis for gathering data to be used to measure the need for services and to design human service programs to evaluate effectiveness.
■ A mechanism for clearer communication among social work practitioners and between practitioners, administrators, and researchers.
■ A basis for clarifying the domain of social work in human service fields (Karls &Wandrei, 1996a).
In professional
practice, tools such as the PIE
can facilitate the
identification and assessment of clients from a person-in-environment perspective that
is easy for social workers to accept as comprehensive. When compared with the DSM-IV-TR and DSM-5, the PIE provides mental health
professionals with a classification
system that enables them
to codify the numerous environmental factors considered when they
look at an individual’s situation.
Classification systems like the PIE allow mental health professionals
to first recognize and later
systematically address social factors in the context of the client’s environment. The PIE can help professionals to
obtain a clearer sense of the relationship the
problem has to the environment in a friendly and adaptable way.
References
SOPHIA F. DZIEGIELEWSK, 2015, DSM-5TM in Action, by John Wiley & Sons,
Inc.
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