Needs assessment of community-based services for children and youth with emotional or behavioral disorders and their families: Part 2. Implementation in a local system of care

In a previous article, rationale and procedures were presented for a model needs assessment of community-based services for children and youth with emotional and behavioral disorders and their families. In this article, the authors describe initial needs assessment planning activities, examine the implementation of the proposed model, provide a general overview of the results, and review how the community that conducted the assessment used the information to identify system development priorities and action plans. Quantitative data are provided on the population demographics and parent and direct service provider surveys. Qualitative data are presented on the semistructured interviews with key stakeholders and direct service providers.     

Children's Services Planning in Northern Ireland: Developing a Planning Model to Address Rights and Needs

This article reflects on a number of key concepts and planning tools that have been developed or adapted through the inter-agency planning of services for children and young people in Northern Ireland (Children's Services Planning). These conceptual models have been developed between 1999 and 2005 and illustrate the key contribution of Children's Services Planning to two significant shifts in how the planning task has been understood. These refer to, firstly, the movement from service orientation to needs orientation, and secondly, the progression from needs to rights within service planning.

Children's Services Planning in Northern Ireland is now based on the United Nations Convention on the Rights of the Child and the Whole Child Model, which demonstrates the understanding that there is no such thing as a uni-dimensional child who only requires services from one agency. The Family Support model has been in use for some years within the process, and the joint outcomes framework, to be designed to enable agencies to address rights and needs has also been adopted across all four Children and Young People's Committees. In terms of outcomes, an overarching Strategy for Children and Young People will develop an outcomes framework within Northern Ireland, which is likely to build upon that of Every Child Matters, as well as children's rights. Children's Services Planning has also demonstrated that the approach to planning of universal services must be consistent with the planning of services for children with additional needs. There needs to be a strong linkage between the planning and delivery of universal and targeted services.

It is a contention of the article that concepts such as those described are required for multi-sectoral planning, and that a whole system planning approach is required to address the rights and needs of children and young people.     

A client-centered approach to family planning: the Davao project

The reproductive health approach to family planning shifts the focus of service provision from macro-level demographic objectives to meeting clients' needs. Little field experience exists to date, however, to indicate how to implement this approach. This study describes a field project in Davao del Norte and Compostela Valley provinces in the Philippines that implemented the reproductive health approach on a quasi-experimental basis. The intervention was designed to address clients' self-defined reproductive needs by providing them with relevant and accurate information and services of good quality. It consisted of two components: Providers were trained in information exchange at fixed clinics, and supervisors were trained in facilitative supervision. The results presented here indicate that the client-centered intervention was successful in enhancing service providers' knowledge and improving the content of information exchange between providers and clients. One provincial health officer has expanded the intervention throughout his province, while other provinces are interested in duplicating the model.     

Understanding health information needs and gaps in the health care system in Uttar Pradesh, India

Health information and the channels that facilitate the flow and exchange of this information to and among health care providers are key elements of a strong health system that offers high-quality services,yet few studies have examined how health care workers define, obtain, and apply information in the course of their daily work. To better understand health information needs and barriers across all of levels of the health care system, the authors conducted a needs assessment in Lucknow, Uttar Pradesh, India. Data collection consisted of 46 key informant interviews and 9 focus group discussions. Results of the needs assessment pointed to the following themes: (a) perceptions or definitions of health information related to daily tasks performed at different levels of the health system; (b) information flow in the public health structure; (c) need for practical information; and (d) criteria for usability of information. This needs assessment found that health information needs vary across the health system in Uttar Pradesh. Information needs are dynamic and encompass programmatic and service delivery information. Providing actionable information across all levels is a key means to strengthen the health system and improve the quality of services. An adequate assessment of health information needs, including opportunities, barriers, and gaps, is a prerequisite to designing effective communication of actionable information.     

Is it time to abandon care planning in mental health services? A qualitative study exploring the views of professionals,service users and carers

Background

It has been established that mental health‐care planning does not adequately respond to the needs of those accessing services. Understanding the reasons for this and identifying whose needs care plans serve requires an exploration of the perspectives of service users, carers and professionals within the wider organizational context.

Objective

To explore the current operationalization of care planning and perceptions of its function within mental health services from the perspectives of multiple stakeholders.

Settings and participants

Participants included 21 mental health professionals, 29 service users and 4 carers from seven Mental Health Trusts in England. All participants had experience of care planning processes within secondary mental health‐care services.

Methods

Fifty‐four semi‐structured interviews were conducted with participants and analysed utilizing a qualitative framework approach.

Findings

Care plans and care planning were characterized by a failure to meet the complexity of mental health needs, and care planning processes were seen to prioritize organizational agendas and risk prevention which distanced care planning from the everyday lives of service users.

Discussion and conclusions

Care planning is recognized, embedded and well established in the practices of mental health professionals and service users. However, it is considered too superficial and mainly irrelevant to users for managing mental health in their everyday lives. Those responsible for the planning and delivery of mental health services should consider ways to increase the relevance of care planning to the everyday lives of service users including separating risk from holistic needs assessment, using support aids and utilizing a peer workforce in this regard.     

Involving communities in health service planning in primary care

Recent health service policy in the United Kingdom has emphasized the need to involve local people in health service planning. This paper will describe how local communities were involved in the development of Primary Care Resource Centres. These centres are designed to provide a base for the delivery of a range of health, social welfare and information services within a community setting. Four centres in the process of being developed in one region were selected for in-depth study. The main method of data collection consisted of semi-structured interviews with key “stakeholders”, namely purchasers and providers of primary health care, social care providers, hospital outreach staff and local community and voluntary group workers (Weiss 1983). This paper examines how the health service organizations developing the centres involved local communities in planning them and the obstacles and difficulties encountered. The paper suggests lessons that can be learned for future community involvement in the planning of local health services.     

Needs and needs assessment: their components and definitions with reference to dementia

The concept of need and the practice of needs assessment are both subject to a wide range of interpretations, to the likely detriment of individual assessments and to multidisciplinary working. Clear definition is important for individual assessment, for the development of multidisciplinary tools and in gathering planning information. The concept of need is clarified, firstly by distinguishing between need and the difficulties that engender it, and secondly through a taxonomy of need. These assist clear definitions of both need and needs assessment when linked with a consideration of the current help a person receives and a specification of the type of help required by a person to meet their needs. Such definitions have implications for the role of needs assessment in individual assessment, service evaluation, service management and planning and in the development of multidisciplinary needs assessment tools.     

武汉市部分老年人长期照护需求研究

介绍了老年人长期照护需求的意义和国内外概况,对老年人对社会性长期照护服务需求的总体情况进行了详细分析,并进行了讨论,提出了政策性建议。     

Barriers and opportunities for evidence-based health service planning: the example of developing a Decision Analytic Model to plan services for sexually transmitted infections in the UK

ABSTRACT: BACKGROUND: Decision Analytic Models (DAMs) are established means of differentiating between health technologies. They have mainly been used to inform clinical decisions and health technology assessment at the national level, yet can also inform local health service planning. For this, a DAM must take into account the needs of the local population, but also the needs of those planning its services. Drawing on our experiences from stakeholder consultations, where we presented the potential utility of a DAM for planning local health services for sexually transmitted infections (STIs) in the UK, and the evidence it could use to inform decisions regarding different combinations of service provision, in terms of their costs, cost-effectiveness, and public health outcomes, we discuss the barriers perceived by stakeholders to the use of DAMs to inform service planning for local populations, including (1) a tension between individual and population perspectives; (2) reductionism; and (3) a lack of transparency regarding models, their assumptions, and the motivations of those generating models. DISCUSSION: Technological advances, including improvements in computing capability, are facilitating the development and use of models such as DAMs for health service planning. However, given the current scepticism among many stakeholders, encouraging informed critique and promoting trust in models to aid health service planning is vital, for example by making available and explicit the methods and assumptions underlying each model, and associated limitations. This can be achieved by consultation and training with the intended users, and by allowing access to the workings of the models (e.g. via the internet), to show how they actually work. SUMMARY: Constructive discussion and education will help build a consensus on the purposes of STI services, the need for service planning to be evidence-based, and the potential for mathematical tools like DAMs to facilitate this.     

Health care needs assessment in prisons: a toolkit

BACKGROUND: Since 1999, prison health services and health authorities have been jointly responsible for assessing the health care needs of the prison population. To facilitate this process, the Department of Public Health and Epidemiology at the University of Birmingham developed a toolkit for carrying out a health care needs assessment of the prison population. METHODS: This paper describes the principles of the epidemiological approach to needs assessment and presents a stepped approach to carrying out a health care needs assessment in prisons. Some examples of the kind of health care needs to be found in prisons are presented. RESULTS: A systematic approach to the assessment of the health care needs of prisoners ensures that all the essential components of this important planning exercise are considered. The prison population is described, health problems are identified and quantified, and a review of current services is carried out. This allows the most effective solutions to addressing the health problems to be established. The process can be time consuming and is reliant on good data sources, but it does ensure that health problems and service elements are considered and addressed together rather than in a disjointed manner. CONCLUSION: The stepped approach to epidemiological needs assessment allows health problems and current services to be identified. It also allows these to be matched to appropriate service requirements.     

Methodological Complexities and the Use of GIS in Conducting a Community Needs Assessment of a Large U.S. Municipality

Reliable assessment of health and social needs within a community ensures that local input drives strategic planning and programmatic decisions. Results are used to determine the priorities and focus of local public health departments and to support the activities of health and social service agencies. We utilized a geographic information system in the planning, administration, and analysis of a recent community needs assessment to ensure a reliable and randomly distributed sample of a diverse urban population and to allow for small geographic area analysis of disease prevalence data. Collection of location data at the time of the 3,361 face-to-face assessment interviews allowed for the association of spatial data with measures of health conditions and behaviors. Results of the assessment indicated a need for public health programs designed to address emerging public health concerns in the community. Incorporating a spatial component in analyses of morbidity and needs assessment data allows for efficient integration of demographic and socio-economic census data and permits ad hoc analyses of varied and changing geographic strata.     

The process of decision-making in home-care case management: implications for the introduction of universal assessment and information technology

Increasingly, jurisdictions are adopting universal assessment procedures and information technology to aid in healthcare data collection and care planning. Before their potential can be realised, a better understanding is needed of how these systems can best be used to support clinical practice. We investigated the decision-making process and information needs of home-care case managers in Ontario, Canada, prior to the widespread use of universal assessment, with a view of determining how universal assessment and information technology could best support this work. Three focus groups and two individual interviews were conducted; questioning focused on decision-making in the post-acute care of individuals recovering from a hip fracture. We found that case managers' decisional process was one of a clinician–broker, combining clinical expertise and information about local services to support patient goals within the context of limited resources. This process represented expert decision-making, and the case managers valued their ability to carry out non-standardised interviews and override system directives when they noted that data may be misleading. Clear information needs were found in four areas: services available outside of their regions, patient medical information, patient pre-morbid functional status and partner/spouse health and functional status. Implications for the use of universal assessment are discussed. Recommendations are made for further research to determine the impact of universal assessment and information technology on the process and outcome of home-care case manager decision-making.     

Nursing assessment in industry.

In order to be able to offer nursing service to industry, a community health agency must have some knowledge of the industry and the daily problesm faced by both management and worker. The nursing process can serve as a framework for the gathering of necessary information and planning of sound care. The five-step nursing process, which includes assessment, diagnosis, planning, implementation and evaluation, is discussed and annotated model Assessment Guide for Nursing in Industry is given (Appendix A). The six areas from which information should be gathered when assessing an industry are the following: I. The community in which the industry is located: II. The industry, its historical development, policies, and projections; III. The plant or physical structure; IV. The working population; V. The industrial process of the plant; VII. The existing health program. Once the assessment is completed and a diagnosis formulated, services can be offered based on specific, defined needs.     

Service integration and co-ordination: a framework of approaches for the delivery of co-ordinated care to children with disabilities and their families

This article clarifies the nature of 'service integration' and 'service co-ordination' and discusses how these aspects relate to the fundamental goal of providing co-ordinated care for children with disabilities and their families. Based on a review of the service delivery literatures in the fields of health, social services and rehabilitation, a framework is presented that outlines the scope of the co-ordination-related functions and activities encompassed in three common types of approaches to the delivery of co-ordinated care. These are a system/sector-based service integration approach, an agency-based service integration approach and a client/family-based service co-ordination approach. The functions outlined in the framework include aggregate-level planning of services (designed to map out the scope and plan for service provision in a community or geographical area), administrative functions (designed to ensure wise and equitable access to resources) and client-specific service delivery functions (designed to link clients/families to needed services). The framework is a tool that can be used to support policy making and decision making with respect to the design of efforts to provide co-ordinated care. It provides information about commonly used approaches and the essential elements of these approaches, which can be used in making choices about the scope and nature of an approach towards service integration/co-ordination.     

Ethnic health workers in primary health care

Abstract: Ethnic health workers were employed to increase the access of communities of non-English-speaking background to health services, but their role has remained unclear in a national health system that has been criticised for being slow to respond to the needs of these communities. Interviews and a questionnaire were used to survey a convenience sample of 40 South Australian ethnic health, welfare and community workers and 17 supervisors about the important roles of ethnic health workers, how they should perform their roles and their ability to fulfil them. Interviews with 11 staff from the New South Wales Ethnic Health Worker Program then provided a broader perspective to the South Australian findings. High-priority roles were to provide help to solve immediate health problems. Roles included providing access as well as services. There were pressures on ethnic health workers to become service providers: clients from non-English-speaking backgrounds expected assistance with a wide range of problems, and mainstream staff lacked competence in meeting these needs. Ethnic health workers' involvement in needs assessment and health agency change was limited by these pressures, by ethnic health workers' separation from the work of mainstream staff and because systematic planning of services to non-English-speaking communities was lacking. The appropriate role for an ethnic health worker is as an access provider, with a greater emphasis on needs assessment and agency change. Agencies need to develop culturally appropriate service plans and training so that ethnic health workers and mainstream staff are better able to work together.     

The influence of health needs assessment on health care decision-making in London health authorities.

OBJECTIVES: Health needs assessment gained prominence under the model of health care purchasing developed to support the 1991 reforms of the UK National Health Service (NHS). The objectives of this paper are to determine how needs assessment has been used in the NHS, to assess the influence it has had on decision-making, and to relate the observed uses of needs assessment to competing theoretical models of health care policy-making. METHODS: A survey of needs assessment activity in 14 London health authorities identified 217 needs assessments conducted between 1993 and 1996. Semi-structured interviews were conducted with public health and commissioning staff in each authority. RESULTS: The survey indicated that needs assessment directly supported decision-making and action in two-thirds of the studies identified, but up to 20% of needs assessments had no impact on service provision. Four key functions of health needs assessment were observed: identifying a problem; planning detailed changes to services; providing post hoc justification for earlier decisions; and using participation in needs assessment to build 'ownership' of subsequent decisions. CONCLUSIONS: The survey suggests that needs assessment is, in practice, consistent with a 'mixed scanning' model of decision-making. Needs assessment is used to help select issues for detailed investigation and to direct analytical and decision-making resources. However, certain key areas are not amenable to technical analysis and solution, and are resolved through bargaining.     

'Carers' of people with mental health problems: proposals in current public mental health policy in nine countries

This study investigates how public mental health policy addresses the role and needs of those who care for people with mental health problems. Public mental health policy recognises that carers are at increased risk of poor health. Countries want to ensure that mental health services are responsive to the needs of "carers", that carers participate in the planning and implementation of services and that more information should be made available to carers. Respite care is recommended as a way to improve the health of both carers and service users. Unfortunately, policies only identify possibilities for intervention, and rarely identify specific actions to be taken or clarify who has responsibility for delivering interventions. Further the financial implications of the proposals and the need for additional trained staff are seldom discussed. Current proposals for helping carers are inadequate.     

市县级妇幼保健与计划生育服务机构资源整合研究

为推动妇幼保健机构和计划生育服务机构的资源整合,采用现场问卷调查、专题小组访谈、个人深入访谈等方法调查了7个省的5个地市级和9个区县级14所完成了妇幼保健和计划生育整合的实施机构。了解其资源整合模式、资产归属、人员安置和人员薪酬分配等内容,梳理归纳了整合中存在的技术人员未得到有效补充、人员培养和配备不能满足新形势需求、免费计划生育技术服务政策落实受到影响、妇幼保健与计划生育信息整合有待加强、科室设置还需规范等问题,提出建立健全补偿与激励机制、加强人才队伍建设、加强绩效考核和薪酬管理、加强医疗服务机构价格管理和信息化建设、做好生育全程优质服务等建议,为我国妇幼保健和计划生育服务的资源整合提供借鉴。     

A resource inventory approach to needs assessment: Examples from a statewide hypertension control program

Policy decisions regarding the effective allocation of program resources by State government require information on population service requirements, as well as the current supply and distribution of such services. A resource inventory and needs assessment study has proven valuable in assisting such decision making for hypertension services in West Virginia. The development of a profile assessment technique employing the resource inventory has taken a program about which virtually nothing was known to a position whereby extensive information is available for decision making.