Health Needs Assessment Tools Currently in Use

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- Health Needs Assessment Tools currently in
use

Josephine M Green (Professor of Psychosocial reproductive health)    

  Mother and Infant Research Unit (MIRU) University of York      

June 2008

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Table of Contents 1 2 3 4 5 6 7 8 Introduction.......................................................................................................... 3 Common Assessment Framework (CAF) ............................................................ 4 Derby City Public Health Needs Assessment Tool .............................................. 6 Tynedale Health Needs Assessment Tool (THNAT) ........................................... 6 Kirklees Health Needs Assessment .................................................................... 7 Universal Needs Assessment (UNA)................................................................... 9 Conclusions......................................................................................................... 9 References ........................................................................................................ 10

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1

Introduction

In the debate as to how to identify those families who require additional services because their children are at risk of poor outcomes, research attention has focused on whether Health Visitors should use structured assessment tools or rely on unstructured assessments and professional judgement to target their resources appropriately. In a review of clinical practice guidelines used to identify families requiring increased Health Visitor support, Appleton (1997) analysed 77 separate guidelines from 67 community NHS trusts. The guidelines ranged between professional judgement only, an aide memoire for risk assessment, through lists of risk factors and risk indices to checklists and screening tools with a scoring system. Appleton found that nearly half (35) were checklists, screening tools or a scoring system and a further quarter (19) were a list of risk factors/risk indices. Of the checklists 21 (60%) recognised professional judgement as a component of decision making and included questions which asked about ‘Gut feeling’ or ‘Families who make one feel instinctively uneasy’. In an examination of Health Visitors’ use of formal guidelines, Appleton and Cowley (2004) concluded that many Health Visitors make limited use of guidelines in practice and that ‘in reality Health Visitors use their own professional judgement in making family assessments’ (p 794). Mitcheson and Cowley (2003) highlighted Health Visitors’ concerns about using assessment tools because they believed that they distort inter-personal relationships and communication and impose a professionally-led agenda, leading to missed cues and failure to identify needs which are relevant to the client. In a qualitative study of the acceptability and effectiveness of a structured health needs assessment tool, Cowley and Houston (2003) identified a number of Health Visitors’ and clients’ concerns. A structured health needs assessment tool (HNAT) was considered to interrupt the flow of the interaction and some Health Visitors asked questions but did not listen to or respond to the answers; there was a tendency to use it as if it was a structured questionnaire when it was intended as a guide; some clients found it too direct and felt that some of the questions were judgemental. Overall the use of an HNAT ‘did not ensure that all needs were identified but did intrude into normal practice, impeding rather than improving it’ (p 88). They concluded that ‘This structured form of needs assessment appears neither acceptable nor effective as a means of selecting target clients for health visiting from an undifferentiated caseload’ (p 89).

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