By: Dr. John Lyons

Chapin Hall at the University of Chicago

A few years ago, I was in Hawai’i over Memorial Day. At the recommendation of a local colleague we attended the candle floating ceremony on Oahu. In the ceremony, people create candles commemorating lost loved ones and float them out to sea together. The experience was very moving as a powerful visual representation of love.

The theme of the ceremony that year was “Many rivers. One ocean”. That theme could very well describe the design of a communimetric tool. Although there are many story tellers in people’s lives there is still just one person, and it is their story. The goal of the CANS is to represent a commonly understood story that integrates the perspectives of all story tellers. Just as there are many rivers (story tellers) there is ultimately one ocean (the person’s story).

I really haven’t met too many people who would argue it shouldn’t be that way. The most common argument against a common story approach comes from people who view themselves as experts. They worry that somehow, if their expertise-driven story of the person is integrated with other story tellers, that their story will be lost. Some worry they will become accountable for a story they only had a part in telling. It is not a sustainable argument.

The assessor does not own the story. The assessor is not the story teller. Each individual owns their own story, and any effective helper knows this. The assessor gives information to be woven into that story, helps identify potential patterns and themes in the story and assists in organizing other perspectives. The process of integrating many rivers into one ocean–or many perspectives into one story owned by the person who is living it–is person-centered, consensus based assessment. This integration of stories is, simply, good care.

Consensus-based assessment arises in situations where multiple sectors or multiple providers are mandated to complete unique assessments. This creates operational challenges to the integration of perspectives into an integrated story. Here is our suggestion for managing this type of complexity:

  1. If one assessment was completed prior, the next assessor should do due diligence to secure a copy and build their assessment process as a check-in to see whether anything has changed or if new information is available to be shared.
  2. If the multiple assessments are to be completed during the same time period then we recommend they be done collaboratively. That does not require everyone to be in the room at the same time, although that would be ideal. All that is required would be that the various mandated assessors talk to each other to ensure that everyone is on the same page.

Some have argued if they are paid to do the assessment, then they cannot look at any versions of the assessment–they have to do it entirely themselves. That is untrue. What assessors get paid to do is complete the assessment. Any competent assessor knows the best assessments are based on as much information as is available. Building off other completed versions of the tool keeps the focus on the person and their story, not on the sole views of the assessor.

It certainly takes more time to complete a strong, consensus-based assessment process. But the evidence suggests slowing down to speed up is essential to ensure client engagement and the provision of good care. The effectiveness-related benefits outweigh the costs of putting more time into the process.

Each of us has to decide who we are professionally: Are we a profession of people who do required tasks as efficiently as possible? Or, are we professionals who take our time to help individuals create, document, communicates, and maintain a comprehensive understanding of their stories? Creating one, powerful ‘ocean’ allows us to effectively communicate with, and on behalf of, individuals to guide practice. In this way we can together achieve personal, program, and system transformation.

3 Responses

  1. Like most things written by John Lyons, there are many powerful insights in this little piece, and they are so compactly stated, one could miss the profundity. First, the overall concept of collaborative assessment is important, and it is important to note that expertise is not diminished in this approach — but instead is located appropriately as one more input to help get a full picture. Experts provide helpful insight, but it is only as helpful as it is relevant to the work and insights of the whole team–and most importantly, the client themselves. Assessment needs to be the collecting of various wisdoms, not just the highlighting of this one professional’s procedure. This leads to both better insights, as well as better treatment planning.

    This means expert assessments are not just a person applying abstract knowledge to one client’s specific care. Instead, that expert is a person who knows the ins and outs of cultivating all of the knowledge available: making phone calls, asking for old documents, making sure everyone is in agreement on one is being seen and next steps, and also identifying those things where there are still disagreements at this time, so they need to be handled effectively. This expertise in collaboration and assessment is at the heart of all TCOM trainings, and is why the approach is powerful, and meaningful to consumers, and the system as a whole.

  2. Great Read John! This Reminds Us That We Are All Working to Serve and To Do This We Must Listen As Much As To Talk!

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