| Course | MSW 554 Advanced Techniques for Anti-Racist Practice |
|---|---|
| Week | 3 |
| Paper type | Intake form redesign |
| Length | About 520 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Social Work (MSW) |
| Updated | October 2026 |
Free sample paper for MSW 554 Week 3
Intake Form Redesign for an Outpatient Counseling Agency: The Current Demographic Page Reproduced and Numbered, Each Item With Existing Text, Replacement Text and a Reason, Order as a Design Choice and Items Removed Outright
Student Name
Chamberlain University
MSW 554: Advanced Techniques for Anti-Racist Practice
Instructor Name
Month Day, Year
Intake Form Redesign for an Outpatient Counseling Agency: The Current Demographic Page Reproduced and Numbered, Each Item With Existing Text, Replacement Text and a Reason, Order as a Design Choice and Items Removed Outright
The Current Page
1. Name. 2. Date of birth. 3. Sex: M / F. 4. Race: White / Black / Hispanic / Other ____. 5. Primary language: English / Spanish / Other. 6. Marital status: Single / Married / Divorced / Widowed. 7. Are you a legal resident of the United States? Yes / No. 8. Emergency contact.
Item Entries
Item 3. Existing: "Sex: M / F." Replacement: "Sex assigned at birth: Female / Male / Prefer not to answer" and a separate optional item: "Gender: ____." Reason: the agency's billing needs sex assigned at birth; the open gender item lets clients describe themselves.
Item 4. Existing: "Race: White / Black / Hispanic / Other ____." Replacement: "Which of these describe you? Select all that apply: American Indian or Alaska Native; Asian; Black or African American; Hispanic or Latino; Middle Eastern or North African; Native Hawaiian or Pacific Islander; White; Another: ____; Prefer not to answer." Reason: the current item treats Hispanic as a race, forces one choice and has no option to decline. The replacement follows the combined question in the 2024 revision of the federal race and ethnicity standards (Revisions to OMB's Statistical Policy Directive No. 15, 2024).
Item 5. Existing: "Primary language: English / Spanish / Other." Replacement: "What language do you prefer for appointments? ____. Would you like an interpreter at no cost? Yes / No." Reason: the item should collect what the agency will act on, which is interpreter need.
Item 6. Existing: marital status with four options. Replacement: removed; household members are asked in the interview. Reason: the agency does not use marital status, and the categories leave out unmarried partners.
Item 7. Existing: "Are you a legal resident of the United States?" Replacement: removed. Reason: the agency does not need immigration status to provide services, and the question frightens clients away.
Order Is Part of the Design
Name, contact and language now come first, so a client who needs an interpreter is offered one before reading the rest. Race and ethnicity move to the end, after the services the agency offers are described.
Response Options Are Wording Too
Every demographic item now has "Prefer not to answer." A forced answer collects bad data and signals that the agency's needs come first.
What the Items Collect, and for Whom
A short line at the top explains: "We ask these questions to make sure our services reach everyone fairly. Your answers do not affect your care." The NASW standards on cultural competence ask agencies to examine their own practices for bias (National Association of Social Workers, 2015).
References
National Association of Social Workers. (2015). Standards and indicators for cultural competence in social work practice. National Association of Social Workers.
Revisions to OMB's Statistical Policy Directive No. 15, 89 Fed. Reg. 22182 (2024).
What the MSW 554 Week 3 assignment asks for
The intake form redesign starts with the current form reproduced and numbered, so every change has something to point to. For each item you change, give the existing text, the replacement text and a reason. Remove items the agency does not use or that harm trust, and say why. Treat order and response options as part of the design, not afterthoughts: what comes first, what comes last and whether a person can decline. Explain what the items are collected for and tell the client so at the top. Where a federal or state standard applies, such as race and ethnicity categories, follow it and cite it. Keep the reasons short and concrete.
How the MSW 554 Week 3 example is put together
The current page lists eight numbered items from name to emergency contact. Item 3 becomes sex assigned at birth for billing with an optional open gender item. Item 4 becomes a combined race and ethnicity question with select all that apply and prefer not to answer, following the 2024 revision of the federal standard. Item 5 asks about appointment language and interpreter need. Items 6 and 7, marital status and legal residency, are removed with reasons. The order section moves language to the front and demographics to the end. The response options section adds a decline option everywhere. The purpose line is quoted, and NASW (2015) standards on agency practice are cited.
Where the points sit in the MSW 554 Week 3 rubric
Assessors look for the current form reproduced and a reason for every change. A redesign that presents only the new form loses the most. Credit goes to numbered items, existing and replacement text side by side, reasons that refer to what the agency does with the data, removals justified and attention to order and response options. Federal standards should be cited accurately in legal or APA form. A purpose statement written for clients earns marks. The redesign should be realistic for the agency's systems, such as billing fields that must stay. Showing how a change affects the client's first minutes with the form, such as being offered an interpreter before anything else, demonstrates design thinking.
MSW 554 Week 3 help from the desk
Redesigns most often lose points by adding categories without asking what the agency will do with them. Another common gap is leaving out a decline option, which forces answers and lowers data quality. Some papers change wording without explaining the harm in the original. Others remove items the agency legally needs, such as fields required for billing. If you do not have access to your agency's form, use a published sample and say where it came from. A redesign that a quality coordinator could adopt next month, item by item, shows the change is practical as well as principled. Read your new page as a nervous first-time client would, top to bottom, and note any item that would make you hesitate to continue.
Get a MSW-554 Week 3 example written to your instructions
Send the actual instrument where you can share it with identifying material taken out, together with the assignment and the rubric, and a custom MSW-554 Week 3 redesign comes back within 24 to 48 hours. Where a form cannot leave the building, the sample is built on a constructed one of the same type. First sample free.
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MSW 554 Week 3 questions, answered
Which items are usually the ones to cut?
The ones collected out of habit and never used: a fax number, a second emergency contact nobody calls, a marital status field that changes no decision anybody makes. The example keeps a note against every cut saying what the agency stops knowing, because a deletion defended that way is far harder to argue with.
Should the redesign keep the race and ethnicity question?
Usually yes, and the work goes into the material around it rather than into removing it. The example writes a short line saying why the agency asks, states where the answer travels afterward, and offers a category set a person can find themselves inside, including space to write their own words.
How much of the form has to be covered?
Depth beats breadth in most sections. A whole instrument skimmed produces one-line comments, while a single page treated properly, with stems, options, order and requiredness all decided, gives a grader something to mark. The assignment normally states how many items it wants, and that figure is smaller than writers assume.
Where can I find a free MSW 554 Week 3 sample paper?
The complete MSW 554 Week 3 redesign of an agency's demographic intake page, every changed item with its old text, new text and reason, appears lower down.
Which items were removed in the MSW 554 Week 3 sample?
Marital status, which the agency does not use and which leaves out unmarried partners, and legal residency, which the agency does not need and which frightens clients away.