[humanser] Question about Recognizing and Reporting on NonvisualCharacteristics of Clients

[Tabea Meyer]

Sarah,
I'm so glad you brought up these questions and so thoroughly explained
your thoughts.
JD, thank you so much for sharing your thoughts, suggestions, and
practices. They are so helpful!
Thank you both!
Tabea

On 11/15/17, Cheryl Wade via HumanSer <humanser at nfbnet.org> wrote:
> Listers,
>
>
> This is truly excellent!
>
>
> Cheryl Wade, MA, LLPC, CRC
>
>
> On 11/13/2017 12:54 PM, JD Townsend via HumanSer wrote:
>> Hello:
>>
>> No problem, just ask.
>>
>> I find my assessments are fuller than most at my hospital, perhaps
>> especially in the appearance category.
>>
>> “What color is your hair and how do you wear it can” can tell you a lot,
>> like blue hair or a wig.
>>
>> “How do you dress” can identify casual, neat, disheveled or your nose can
>> tell you dirty.
>>
>> Asking about height and weight can identify not only facts, but also
>> feelings about them.
>>
>> I always ask about skin color, ethnic identification, and sex, things
>> visual observations do not accurately identify.
>>
>> AND,  I have found no research in professional journals to support the
>> reliability of visual observations.  However, there is research to the
>> unreliability of visual observations.
>>
>> A dissertation on this topic is needed.
>>
>> Personally, I can hear a limp, figiting, hand or foot tapping, and, at
>> times, “hear” eye rolling (smile).  Facial expressions are not a valid
>> identifier of mood states.  A smiling face often hides a depression,
>> needing to please.  An angry face can hide a gentle homeless person
>> providing them with a bit of protection.
>>
>> Your questions about eye contact and age judgement will come to you in
>> time, but are, for me, more difficult.  Look for where the patient’s voice
>> is coming from, aimed at the floor or the door.  Listen to verbal
>> production for age.  Or, ask reception for a quick picture.
>>
>> Best of luck.
>>
>>
>> JD Townsend, LCSW
>>
>> Helping the light dependent to see
>> Daytona Beach FL Earth
>>
>> From: Sarah Meyer via HumanSer
>> Sent: Saturday, November 11, 2017 4:33 PM
>> To: humanser at nfbnet.org
>> Cc: Sarah Meyer
>> Subject: [humanser] Question about Recognizing and Reporting on
>> NonvisualCharacteristics of Clients
>>
>> Good afternoon,
>> I haven’t posted to this Listserv in a while (grad school is great but
>> all-consuming, haha), but I hope you are all well.
>> I am writing to get some feedback on how blind practitioners have
>> addressed the visual appearance/physical characteristics of the mental
>> status exam. I am currently taking Appraisal Methods in Psychology,
>> and one of our assignments is to perform a full mental status exam on
>> someone and to write a paper/report including assessment and
>> recommendations.
>>
>> According to one of the articles assigned for class, there are
>> physical characteristics and qualities that we aught to be able to
>> “see” and observe without the client even speaking a word, and these
>> are apparently important towards the assessment. I’m wondering how you
>> have handled these types of questions or elements, both in mental
>> status exams, and in writing objective/observational characteristics
>> in progress notes (It sounds weird to say, “It sounded as if client
>> was smiling” or “client sounded sad” when a sighted clinician could
>> say things like “Client was smiling” or “client maintained sad affect
>> for the duration of the session as evidenced by frowning and lowered
>> gaze.”). I realize that many of these characteristics are things we
>> could infer from other cues, but how do you report on nonvisual ways
>> of arriving at these conclusions? Here are questions I have based on
>> the articles I've been reading:
>>
>> 1.	Ethnicity. I realize that this information may be already available
>> if someone else performed the intake, or perhaps the client can tell
>> us themselves, but we can’t see if stated ethnicity matches apparent
>> ethnicity.
>> 2.	Age: How can we identify if stated age matches apparent age without
>> saying something weird like, “client sounded young/childlike” or
>> “client sounded elderly”?
>> 3.	Body build (slim, stocky, muscular, etc.), posture (erect,
>> slumped), walking and other movement quality (graceful, jerky,
>> limping?), physical abnormalities, scars, missing limbs, tattoos?
>> General nutrition?
>> 4.	Hyperalertness, such as glancing around more than usual, as if with
>> suspicion? I imagine there are other clues to this, but how can a
>> mental status exam be complete without even talking about eye contact
>> or the client’s behaviors such as glances and focus?
>> 5.	Clothing and accessories: How can we tell if a client is dressed
>> appropriately for climate and for our meeting with them? How can we
>> determine if clothing is dirty and tattered or clean and well-cared
>> for? Disheveled and wrinkled or in order? Casual or formal?
>> Contemporary or out-of-date? Unbuttoned or buttoned as should be?
>> Overly bright colors apparently can suggest mania; misbuttoned shirts
>> or coats could indicate dementia; and bizarre dress, such as an adult
>> dressed in a Boy Scout uniform, for instance, could indicate
>> psychosis. How do we obtain this important information?
>> 6.	Hairstyle and color? Facial hair? Is it orderly or unkempt?
>> 7.	Motor activity: Some things, like pacing and significant jiggling
>> of a leg, can be heard, but it is harder to tell if someone is sitting
>> on the edge of their seat, tense, or relaxed.
>> 8.	Hands: are they folded or clenched in fists? Are nails dirty,
>> bitten, stained, or manicured? Is there a tremor? Is the client
>> picking at skin or clothing, or rubbing, touching, or scratching
>> anything inappropriately? Again, some things I can imagine being
>> audible, but how do you clarify what is happening without making the
>> client feel uncomfortable?
>> 9.	Involuntary movements? I imagine that noticing movement of the
>> limbs would be easier to detect than involuntary facial movements.
>> 10.	Mannerisms: Stereotypies, posturing, waxy flexibility, negativism,
>> and catalepsy? The article mentions these but says they are rare.
>> Still, how would you assess these?
>> 11.	And of course, the infamous facial expression: eye contact,
>> patterns of gaze or focus, smiling/frowning, normal movements or are
>> they rigid or a fixed expression?
>> 12.	How would you identify the following emotions or cues to emotions?
>> Anger: clenched jaw, knotted fists, flushing of face or neck, drumming
>> fingers, extended neck veins, fixed stare
>> Anxiety: jiggling foot, twisting fingers, affected casualness (such as
>> toothpicking)
>> Sadness: moistening of eyes, drooping shoulders, slowed movements
>> Shame: poor eye contact, blushing, shrugging
>>
>> Thank you for your guidance! Have a great day,
>>
>> -Sarah
>> 	
>
>
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