Clients in community services often present with interrelated needs and issues that coexist and must all be addressed for services and interventions to be effective.
You will need to have a broad understanding of a range of diverse needs; how they relate to each other; and services, service features and approaches used to meet coexisting needs.
By the end of this chapter, you will understand:
- Maslow’s hierarchy of needs
- the nature and impact of diverse and multifaceted needs and issues, and the potential interrelationships between them
- how to analyse a client’s needs using a collaborative approach
- why you must operate within the scope of your work role
- identifying and prioritising needs with your client
Maslow’s Hierarchy of Needs
If we look at Maslow’s hierarchy of needs, we can see that needs are all interrelated, so if needs are not met in one area, this will have an impact on other areas.
Needs located lower on the hierarchy must be met before needs at higher levels can be addressed. For example, if our physiological and safety needs are not met, we may not be able to engage in relationships that provide love and belonging, or we may not feel worthwhile and valued so our self-esteem needs may not be met.
Poverty and homelessness can result in physical and mental health issues. Living with domestic and family violence can result in trauma and associated mental health issues, and damage to self-esteem.
Attempting to cope with difficult issues such as these by using alcohol or drugs can create further physical and mental health issues and can also damage relationships and self-esteem.
This pattern of relationships between various areas of need creates coexisting needs, some of which lie underneath each other in the hierarchy.
Reflection
Think about your own needs and how they interrelate.
For example:
- If you found yourself without accommodation, what other needs might you find difficult to meet?
- If you developed a serious health issue, what other aspects of your life would be affected? What other needs might you find difficult to meet?
- If you lost the support of your family or a close friend, how would this affect your emotional and psychological wellbeing?
Presenting Needs and Underlying Needs
When we are assessing coexisting needs, it can be helpful to think about them in terms of ‘presenting’ needs and ‘underlying’ needs.
Very simply put, a presenting need or issue is one that your client identifies and seeks help for. A presenting need is the one that the client identifies as the most important issue for them.
An underlying need or issue may ‘lie beneath the surface’, contributing to the presenting issue or problem and making the client’s situation more complex.
Example
Being homeless can create many issues and unmet needs:
- Lack of shelter can lead to physical illness.
- Lack of safety can result in physical injury.
- The stress of being homeless and unsafe can result in psychological damage and mental illness.
So, while your client may be asking for help with a psychological or mental health issue, their lack of safe accommodation may be a significant contributing factor that must also be addressed.
Conversely, an underlying mental illness may contribute to the client becoming homeless.
It is a bit like asking which came first: the chicken or the egg? In one sense, it does not really matter whether a mental health issue led to the client becoming homeless or being homeless gave rise to a mental health issue. What matters is that the two issues are connected and coexist, and both must be addressed.
To identify underlying issues and needs, ask the client questions about what else is going on in their lives, and look for connections between the client’s various issues
Case Study
Andrew
Andrew is 28 years of age. He was diagnosed with schizophrenia when he was in his teens and has had several admissions to psychiatric hospitals. He uses illegal drugs and has been involved in criminal offences to obtain money to buy them. He is currently serving a custodial sentence for robbery and drug dealing.
He continues to use illicit drugs, which are available within the prison.
Think about:
- How Andrew’s mental illness might have led him to try illegal drugs
- How his drug use is connected with his criminal offending and imprisonment
- How his imprisonment might affect his mental health and his continuing drug use
- The connections between his mental illness, drug use and offending behaviour
- What services he might need when he is released from prison.
Lucy and Mark
Lucy is married to Mark. They have four children under the age of six. Mark drinks heavily and is often violent towards Lucy.
When Mark started hitting the children, Lucy took the children and ran away. For the first few months Lucy and the children lived with friends and relatives, sleeping on couches and camping in their backyards. She approached several women’s refuges, but there were no places available. Lucy and the children move on each time Mark finds out where they are living.
At present, Lucy and her children are sleeping in Lucy’s car. Child protection authorities have become involved, and there is a hearing scheduled in the children’s court next week to consider whether the children should be placed in care.
Think about:
- The relationship between experiencing domestic and family violence and becoming homeless
- The impact this has on the children
- What services might be needed to keep Lucy and her children together.
Malcolm
Malcolm is in his 50s. He worked as a manager for a large supermarket chain until he became ill with a degenerative muscular condition and was no longer able to work full time.
This put a strain on his marriage, and he and his wife divorced.
The family home was sold, and Malcolm is now living in a rented studio flat, which is all he can afford.Hestruggles to make ends meet on his JobSeeker allowance from Centrelink, and he has used up most of his savings. He is not old enough to access his superannuation fund, and his only asset is his vehicle.
Malcolm has applied for more than 20 jobs in the past month but has not been successful in obtaining an interview for any of them. He is becoming desperate, and his situation is affecting his physical and mental health. He is two weeks behind on his rent and does not have enough money to fill his car with petrol. He has started drinking to cope with pain from his muscular condition and to forget his problems.
Think about:
- The impact of ill health on Malcolm’s employment, financial/economic position and his marriage
- Factors that might present barriers to Malcolm finding employment
- The impact of his situation on his mental and physical health
- What services Malcolm might need to help him deal with his situation.
Florence
Florence is in her late 70s. She lives alone in a small country town. Her husband died three years ago, and her adult children moved to the city some time ago. She is well known in the town and has a good relationship with her neighbours.
Florence is physically fit but is beginning to show signs of dementia. Her short-term memory is deteriorating, and she often forgets medical appointments and loses track of time and the days of the week. She often cannot find the right word for objects and forgets the names of people she has known for years. When this happens, Florence becomes angry and agitated, pacing up and down, swearing and hitting herself with her fists.
Neighbours have noticed that Florence is often dirty, smelly and unkempt; and her clothes are soiled. She has visibly lost weight and has lost her dentures.
Florence’s next-door neighbour Mary has tried to persuade her to seek help from her GP or to request an Aged Care Assessment Team (ACAT) assessment, but Florence was offended and became aggressive, pushing her neighbour out of the door and throwing a potted plant at her. Mary has contacted Florence’s eldest daughter and asked her to visit to see Florence’s situation for herself.
Think about:
- How the ageing process is affecting Florence’s functioning and her physical and mental health
- Florence’s ‘behaviours of concern’ and what might be contributing to or triggering these
- What services Florence might need to support her to continue living in her own home, if this is what she wants
- What her friends and neighbours can do to help
- What supports her family might need to address the situation and meet Florence’s needs.
Services for diverse coexisting needs
Using a Holistic Perspective or Approach
Taking a holistic perspective or approach when assessing coexisting needs means looking at the whole person and their full range of needs, not simply dealing with each need in isolation. A holistic approach includes recognising the connections between all the different areas of a person’s life and wellbeing, and acknowledging the importance of each one in relation to all the others.
For example, instead of just treating a person’s addiction, a holistic approach would also look at the person’s living situation, family, social networks and relationships, general health, occupation or employment, cultural background and a range of other factors that might be relevant to why and how they became addicted and maintained the addiction. Sources of support would then be identified.
A holistic approach considers factors such as:
- Safety and material needs, including safe and stable accommodation, and meeting physiological needs
- Support for physical and mental health and wellbeing, including access to health and medical care
- Development and learning, including opportunities to develop capacities and skills to address issuesand problems
- Social and emotional wellbeing, including a sense of belonging, self-esteem, fulfilment and meaning
- Supportive relationships with family, friends and community members.
Holistic approaches have been used in the context of health care for some time, but the same principles can also be applied across all sectors of community services work.
Explore
Visit the following links to learn more about holistic approaches:
Watch
This short video provides an example of person-centred care and an holistic needs assessment within a medical and healthcare context:
‘Enabling Person Centred Care Using Holistic Needs Assessment’ by 1000 Lives Improvement on YouTube.
6:36 Minutes
Current best practice across all sectors of community services emphasises working collaboratively with clients and others and using person-centred approaches that also recognise and build on the client’s own capacities and strengths. These approaches are used in assessing clients’ needs.
Collaborating with other service providers and community resources is important when assessing and addressing coexisting needs.
Principles for Effective Collaboration
Collaboration means working together to achieve outcomes that you cannot achieve alone. Community services frequently work together when a single organisation or service does not have the capacity to meet the full range of a client’s needs. Two or more organisations or services share resources and work cooperatively, often using case management to coordinate their activities.
Collaboration may also include other people, such as the client’s family members, carers, partners and friends; and others within the client’s social network or community.
In the context of assessing a person’s diverse and coexisting needs, collaboration works to ensure that all the relevant information is collected and no needs are overlooked. Collaborating also provides a range of different viewpoints, which contribute to creative solutions and problem-solving.
Collaboration increases efficiency as resources are shared.
Key Collaboration Principles.
Evidence-based assessment of successful collaboration highlights six partnership principles:
- Recognise and accept the need for partnership
- Develop clarity and realism of purpose
- Ensure commitment and ownership
- Develop and maintain trust
- Create clear and robust partnership arrangements, and
- Monitor, measure and learn.
- Community Door
Explore
Visit the following links to learn more about collaboration:
‘Collaborative Practice Models’ from Community Door.
‘Networking With Other Community Organisations’ from Resilient Community Organisations
Skills and Strategies for Collaborating With Clients
Effective collaboration with your client to assess their needs is based on recognising the interdependent nature of the relationship between you and your client and respecting the contributions that your client can make. In practical terms, this means accepting that your client is probably the best person to provide information about their own needs.
For a collaborative relationship between you and your client to work, the following elements are required:
- Shared goals
- Mutual trust
- Empathy and understanding
- Acceptance of diverse values and views
- Clear roles and responsibilities
- Compromise and negotiation
- Open respectful communication
Watch
The following video shows a role play of assessing needs and beginning to set goals:‘Initial Assessment Interview for Social Work 505. Widener University’ by Rachel Goldfarb Kowalenko on YouTube.
9:21 Minutes
In practice, this means encouraging and supporting your clients to:
- Identify their own needs, goals and preferences
- Ask questions and express concerns
- Negotiate to resolve conflicts.
You will also need to use and model effective, assertive communication.
Your job role description, position statement or duty statement describes your work role. You must carry out the tasks included in this, and you must not carry out tasks that are not included, unless your supervisor gives you specific directions to do so.
Working within your role protects you and your clients. If you work outside your work role, you may not have the skills or knowledge required to complete additional tasks safely and competently, which puts you and your clients at risk.
Providing your clients with information about your work role and responsibilities, and its boundaries, is good practice. Your clients need a clear idea of what you can and cannot do so they have realistic, accurate expectations of you.
Within the context of assessing clients’ coexisting needs, working within the scope of your role means that you may not be expected or able to conduct specialised assessments. If you have questions about your role in assessing clients’ needs, consult your supervisor.
While you are not expected to have in-depth knowledge of all community services, you need skills in finding information about services and resources to meet your clients’ needs.
Case Study
Jane and Samantha
Jane is a support worker in a community centre. Her role includes assessing clients’ needs for services that fall outside those provided within the centre, and referring clients to external agencies and resources.
Samantha arrives at the centre in distress and tells Jane that she has been issued with an eviction notice by her landlord. She is panicking because she has four young children, one of whom has a significant physical disability, and she is afraid that, if they lose their accommodation, the children will be removed from her care. She also tells Jane her ex-husband has been trying to gain custody of the children, and that this situation has affected her mental health to the extent that she experiences panic attacks and has become fearful of leaving the house.
Jane is not qualified to assess Samantha’s mental health or to give legal advice about tenancy, eviction or custody issues. These tasks do not fall within her work role.Jane spends time talking to Samantha and uses open questions and active listening to collect information about her situation, her feelings and how she sees her situation. She summarises what Samantha tells her and helps her to identify the key issues and needs in her situation, and prioritise them. She also helps Samantha to articulate clear goals and think about how these might be achieved.
She then offers to refer Samantha to a mental health service practitioner to assess her panic attacks and reluctance to leave her house, and to a community law centre for legal advice.
When a client presents with multiple, complex and coexisting needs, it is important to prioritise the various needs in order of urgency and importance. It may not be possible or necessary to address all the client’s needs at the same time.
Which needs are given priority will depend on the specifics of each client’s situation, but there are some general principles and guidelines you can use:
- Identify needs that might pose a significant risk of harm to the client and/or others if they are not addressed, including risks to physical or mental health, safety, survival and immediate wellbeing. Deal with these needs first.
For example:
- If the person is injured, obtain first-aid or medical attention.
- If the person is in physical danger, move them to a place of safety or have the danger removed.
It is common sense to deal with urgent needs and immediate risks as a priority. You may need to deal with emergencies before you have an opportunity to explore other needs, depending on the context in which you are working.
- Support and encourage the client to identify and prioritise their own needs. An intervention is more likely to succeed if the client has some control over planning it.
- Encourage the client to set realistic goals. Provide information about available services and resources so that the client can make informed decisions about which needs to prioritise.
- Support and encourage the client to identify their own strengths and resources. Look within the client’s own social networks, for example, family, friends, neighbours and community, for resources they can access and use.
- See each issue, problem or need as an opportunity for learning and development.
- Be flexible and allow for changes.
Case Study
Sally and Joan
Sally works in the domestic and family violence sector. She is visiting Joan, whose partner is often violent towards her. Joan has visible bruises to her face and a lump on her forehead. Her left arm is bent and looks as if it may be broken. Two of Joan’s children are cowering in a corner of the room crying.
Joan tells Sally that her partner, Jake, has gone to the bottle shop for more beer and she is afraid of what he will do to her when he returns.
Sally helps Joan to pack a bag for herself and the children and agrees to take them all to a women’s refuge to seek crisis accommodation. As they are about to leave, Jake arrives home. He pushes Sally out of the way and begins shouting at Joan and shaking his fist at her. Sally takes the children into the bathroom, locks the door and phones the police.
The police arrive after a few minutes and arrest Jake. Sally calls an ambulance, and Joan is taken to the emergency department of the local hospital.
Once Joan and the children are settled into the women’s refuge, Sally arranges to meet to talk about what else Joan and the children might need.
In conclusion, this chapter has equipped you with a holistic understanding of client needs in community services. You now grasp the fundamentals of Maslow's hierarchy of needs, comprehending the diverse and interconnected nature of clients' multifaceted needs and issues. The chapter has emphasized the importance of employing a collaborative approach in analyzing client needs, fostering a comprehensive and client-centered perspective. Furthermore, you have gained insights into the necessity of operating within the scope of your work role, ensuring a balance between providing effective support and maintaining professional boundaries. Lastly, you've learned practical skills in identifying and prioritizing client needs, empowering you to navigate the complexities of community services with a targeted and strategic approach. This knowledge enhances your ability to deliver impactful interventions that address the unique and interrelated challenges faced by clients.
