Note – a creative way to explore these questions is to write the questions on a card and have the person read and think about them. This avoids the question and answer drill that can be off-putting and can lead to more thoughtful responses:
A strengths based assessment will explore the whole of peoples’ lives while ensuring emphasis is given to the individual’s expressed and pressing priorities. For example, people experiencing problems with mental illness or addiction often place less emphasis on symptom reduction and abstinence than on desired improvements in other areas of life such as work, financial security, safe housing, child care, and relationships.
• Personal strengths: e.g., What are you most proud of in your life? What is one thing you would not change about yourself? What are your best qualities? What are some of the traits people mention when they talk about you? What are one or two things that you see as making you different and unique from others? What makes you smile?
• Interests and activities: e.g., If you could plan the “perfect day,” what would it look like? What do you care about? What matters to you? Name three things that you occasionally look forward to? What dissatisfies you about your life? What do you wish you could change?
• Living environment: e.g., What are the most important things to you when deciding where to live?
• Employment: e.g., What would be your ideal job and why? What skills do you have, for example, artistic or athletic talents, technological expertise, leadership, capacity for work? Think back to before you first began to struggle with the illness, what did you dream of being when you grew up – tell me about it?
• Learning: e.g., What kinds of things have you liked learning about in the past?
• Trauma: e.g., In relationships with other previous or current therapist(s), doctor(s), friends, family, other consumers, teachers, or anyone else, have you ever been treated inappropriately or in ways that were harmful to you (e.g., poor boundaries, sexual inappropriateness, physical abuse, taunting, bullying, etc.)?
• Safety and legal issues: e.g., Do you have any legal issues that are causing you problems?
• Financial: e.g., Would you like to be more independent with managing your finances? If so, how do you think you could do that?
• Lifestyle and Health: e.g., Do you have any concerns about your overall health? What are those concerns? Tell me a bit about your mental health: What does a good day look like? A bad day?
• Choice-Making: e.g., What are the some of the choices that you currently make in your life? Are there choices in your life that are made for you?
• Transportation: e.g., How do you currently get around from place to place? What would help?
• Faith and Spirituality: e.g., What type of spiritual or faith activities do you participate in? How do you find meaning in your life? Where and when do you feel most at peace?
• Relationships and Important People: e.g., Who is the person in your life that believes in you? In what ways does this person convey this belief in you? To what degree is your family, spouse, or significant other available to provide support for you?
• Hopes and Dreams: e.g., Tell me a bit about your hopes or dreams for the future? What you are seeking? What are your goals for yourself?
• Resilience: e.g., What would you say are indicators of your resilience; for example, the attributes of intelligence, sense of humor, optimism, creativity? What helps you get through the day? What are your greatest strengths? What has helped you in the past?
• Mental Health Treatment: e.g., What can the staff do to help? What can you do to help? Who else can help? What services do you want? What, if any, do you want to avoid? What do you hope to accomplish from mental health treatment?
What do you call your problem? What caused it?
- Note: the answer has everything to do with the cultural filters of the person in recovery and can provide you with rich information and possible avenues for discussion of recovery support networks.
Whom do you include as family? Whom do you trust?
- Note: these are the people who may form the person’s recovery support network.
Have you ever been a member of a faith community?
- Note: this is important because many people believe that God has turned a blind eye when they become ill or develop chemical dependency problems and they cease involvement with church, synagogue, mosque or other religious communities.
Are you a member of a faith community now? If so, would you like the Rabbi, Priest, Pastor, Imam, etc. to be part of and involved in your support network? If not, why not?
- Note: it is a rare clergy member who will not participate as best he/she can when called.
Are you now going, or have you ever gone, to an Indigenous Healer for help with your problem? Would you like that person involved as part of your recovery support network?
- Note: this question is especially relevant for Native people, Latinos and people of African origin.
With whom do you have intimate relations and relationships?
- Note: this way of asking about sexual orientation is a bit more sensitive than asking a person’s sexual orientation outright.
Have you ever experienced racism, police brutality, discrimination and/or other forms of oppression?
- Note: expect a wealth of clinical information from this question, if not initially, information will be likely to be forthcoming as a trusting relationship develops.
How do you identify culturally/racially/ethnically?
- Note: mental health practitioners tend to make assumptions about people based on their outward appearances and often, those assumptions are incorrect.
What do you know about your culture? What holidays do you observe? Are they related to your culture?
Has your family always lived in this area?
- Note: this question can elicit histories of emigration and immigration, as well as issues such as sharecropping in families of African origin, migrant workers, etc.
What were the messages about your culture that you received while growing up? What were the messages you received about the cultures of others?
- Note: issues such as self-hate, ethnic privilege and discrimination, reverse and internalized racism, etc. surface with this question
Topics that can be discussed with the person and his or her family/support network (with the person’s permission):
• What type of support, resources, or assistance are you or other members of the person’s support network (current family, spouse, or significant other) able to provide for the person? What would you say about the people in his or her support network in terms of their ability to be helpful, supportive, and communicative? Are there any concerns or limitations that come to mind?
• Would you say the family is resilient, for example, have affirming belief systems, facilitative organizational patterns, and positive communication processes?
Cultural identity of the individual: (Source: American Psychiatric Association, 2013)
Note: The Diagnostic and Statistical Manual of Mental Disorders (DSM) is not a recovery oriented manual but the DSM 5‘s Cultural Formulation Interview (American Psychiatric Association, 2013) offers some questions that can be used as a guide for helping to understand the person and his or her contextual life and experiences. The questions should not necessarily be asked verbatim but can be used as a guide to topics that may be relevant and the questions should be phrased to reflect sensitivity to the person’s background and culture. Not all of the questions will be relevant to every person or in every situation.
• What is your ethnic background?
• In what ways do you identify with your cultural group in your daily life? For example, in types of food you eat, clothing you wear, rituals you follow during the week and on holidays?
• In what ways did your family of origin identify with your cultural group in your daily life growing up?
• In what ways do you identify with mainstream Canadian culture in your daily life?
• What languages do you speak? Which did you speak growing up? Which do you prefer to use now, and in what situations?
• For immigrants or refugees: What kind of job did you have in your country of origin? What kind of job do you have now? What was the impact of immigration on your and your family’s financial situation and professional status?
• For immigrants or refugees: What were your (or your family’s) reasons for immigrating? What were the circumstances of the immigration? (note any dangers involved)
• For immigrants or refugees: What has been the impact of immigration or fleeing from your country of origin on your mental health and that of your family?
Cultural explanations of the individual’s illness:
• What has been your past experience with mental health professionals?
• What other kinds of help have you sought?
• What words do you and your family use to describe symptoms (“idioms for distress”)?
• What is the meaning of the symptoms in relation to norms of your cultural reference group?
• How does your family explain your symptoms?
Cultural factors related to psychosocial environment and levels of functioning:
• What kind of stressors have you been experiencing?
• What kinds of social support are available?
• What religious or other support systems are available? • How do the symptoms impact your functioning?