Assessing Needs

All assessments used to identify and prioritise clients’ needs should be evidence based.

This means emphasising the use of research and research methods to inform the assessment process by:

• Using knowledge from research and practice
• Systematically recording and updating information collected from observation, records, and clients and their family members and significant others.
• Using assessment methods, processes and tools that have empirical evidence of their effectiveness and appropriateness
• Using empirical research methods to evaluate assessment methods, processes and tools.

The type of assessment used will depend on the context for the assessment, the purpose and focus of the assessment, and the issues that the client presents.

Different types of assessment may also be used across different domains or areas of the person’s life; and to assess the needs of different age groups, cultural and ethnic groups, gender groups and other social groups.

Different types of assessment will be used to assess needs relating to health, economic status, developmental issues, behavioural issues, domestic and family violence, mental health and so on.

The different types of assessment include:

Intake Assessments

An intake assessment is carried out to collect information to identify a client’s needs when they first come into a service. The information is used to make decisions about what services to offer the client and to identify any needs for which the client should be referred to an external agency or service.

Domain-Based Assessments

The following image shows common domains and needs:

A domain-based assessment is carried out to collect information about one or more domains, or areas of the client’s life and functioning – for example, development, physical and mental health, cognitive functioning, social functioning, behaviour, and behavioural issues.

A domain-based assessment does not take a holistic approach and is used to focus on a particular domain (or more than one) because that domain has already been identified as being problematic.

For example, a domain based assessment may be carried out with:

• A child who is having difficulty keeping up at school and is also demonstrating behaviours of concern
• An older adult showing signs of cognitive deterioration that may indicate dementia
• A person with a physical health problem that is affecting their mental and emotional wellbeing.

Domain-based assessments are often used to identify an area or domain that might be a significant factor affecting other areas or domains. For example, cognitive decline can be linked to changes in behaviour or emotional distress.

Norm-Based Assessments

A norm-based assessment is used to measure and compare clients’ functioning, behaviours and other characteristics against statistical norms.

Norm-based assessments are used in situations where a client’s functioning or other characteristics differ from the norm and contribute to the client’s difficulties. For example, this assessment may be used in a situation where a client fails to gain employment because their social skills or other behaviours are different from the norm, or because they lack skills that are expected in an employment context.

In the case of a child who is struggling with reading, for example, assessments may be carried out to collect information about that child’s level of literacy in order to compare it with the statistical norms for that age group. The child’s reading is tested using a standardised reading assessment tool, and the child’s scores are then ranked against those of other children who have been assessed using the same instrument.

Competency-Based Assessments

A competency-based assessment is used to assess skills and functioning against set criteria that provide a standard against which to measure performance.

You may be familiar with this type of assessment from your studies in community services. This assessment tests where a client’s skills and knowledge are against performance criteria, and they must achieve a positive rating and meet all the set criteria.

Competency-based assessments may be used in contexts where services are directed towards supporting clients to learn and develop skills. For example, a client with disability may be assessed against set criteria for using public transport safely as part of a transport training program to increase their independence.

Functional Assessments

A functional assessment is carried out to identify the type and level of support a client needs across a number of functional domains, including:

• Daily activities and mobility
• Cognitive functioning, learning and applying knowledge
• Communication
• Social skills, interpersonal interactions and relationships.

Features of the client’s environment, including challenges and supports, are taken into account.

Psychosocial Assessments

A psychosocial assessment covers a range of domains, or areas of life, that affect a client’s psychological wellbeing, including factors such as:

• Cultural background
• Family history
• Significant life events
• Personality
• Medical and psychological history
• Social networks
• Support systems.

This type of assessment is often used in mental health and other health contexts, with young people and with groups such as migrants/refugees/CALD clients and other special-needs groups.

Assessing clients’ needs, especially where there are coexisting or complex needs, is a process that follows clear steps and procedures, similar to the steps in any research process:

1. Prepare.
2. Collect information.
3. Analyse information.
4. Report assessment results.
5. Identify resources and services to meet needs.
6. Evaluate processes and outcomes.

Roles and Responsibilities

People involved in the assessment process include assessors, the client, family members and significant others.

The assessor may be a community services worker and/or other professionals, depending on the type of assessment, the context and the client’s issues and situation.

A community services worker may collect the initial information about the client’s situation, issues and potential service needs; and whether more specialised assessments are required—other professionals such as psychologists, physiotherapists, occupational therapists, health and other practitioners may be called in.

The assessor’s role is to work within the scope of their job role and:

• Follow organisational policies and procedures to identify and prepare relevant assessment processes and assessment tools
• Organise practical aspects of the assessment, such as time, place, facilities and materials
• Explain the assessment process to the client and obtain their informed consent
• Gather existing information from client records and other sources, with the client’s consent
• Work with the client and others to collect information about the client’s situation, needs, goals and preferences
• Seek additional information from specialists and other sources if required.

The client’s role is to:

• Provide relevant information about their current situation, issues, needs, goals and preferences
• If they wish, include information from people such as family members, carers and others
• Ask questions and raise issues
• Work collaboratively with assessors to identify and prioritise their goals, needs and preferences
• Provide feedback about assessment processes and outcomes.

Assessors must meet relevant legal requirements, for example, in relation to privacy, anti-discrimination, duty of care, confidentiality and obtaining informed consent.

They must also work within a relevant code of ethics for their industry sector or profession; and follow their organisation’s policies and procedures for conducting assessments, and recording and reporting the results of assessments.

Assessors must also consider safety aspects, including physical safety, psychological safety and cultural safety.

Ethical Principles for Conducting Assessments

Ethical principles for conducting assessments are similar to ethical principles for conducting research involving human subjects. These principles include:

• Beneficence – This is the intention of doing good and avoiding doing harm. This means that the assessment must be carried out for the benefit of the client, and any potential risks to the client must be identified, addressed and managed.
• Fairness and equity – This includes treating everyone fairly, without discrimination.
• Voluntary participation – This means providing sufficient information for clients to give informed consent to the assessment process and to how the results of the assessment will be used. Consent must be freely given, without persuasion, coercion or trickery.
• Honesty and integrity – This includes conducting assessments accurately and objectively, and reporting the results accurately and honestly.
• No conflicts of interest – Identifying and declaring any potential conflicts of interest.

Impact of the Setting

The setting for an assessment has an impact on how assessments are carried out and how the person being assessed performs, so part of preparing for assessment is to consider how the physical and social environment will affect the client and the assessment process.

For example, ensure the physical environment is private and quiet, and the client is as comfortable as possible. Do what you can to help the client feel at ease, and make sure that any materials or equipment is in good working order.

Collecting information for assessing clients’ coexisting needs uses much the same methods as any form of research.

The two main ways of collecting first-hand information are observation and asking questions.

You can also collect second-hand information from existing records of information that has already been collected, such as reports of previous assessments, client records and similar documents.

Observation

Observation is used to assess behaviour, skills, and performance of tasks and activities, for example, to assess a client’s functional abilities, communication skills, behaviour in specific social situations, or performance of activities such as daily living and personal care tasks.

Observing a client’s behaviour and actions requires skill and concentration. Using a structured checklist makes this task easier and increases accuracy.

It is impossible to observe everything that is happening, so it is important to have a focus for an observation so you direct your attention to key aspects. It is also important to recognise that there may be gaps in what you observe and to back up information from observations with information from other sources, such as existing records and answers to questions.

It is also important to remember that, if a client is aware they are being observed, their behaviour and performance may change.

Asking Questions

We can ask questions verbally or in writing. Questions can be ‘closed’ or ‘open’.

Interviews

Asking questions verbally means interviewing the client, which can be done face to face with individuals or groups, or by telephone. Interviews allow you to check responses and clarify information, or probe for further information.

• Face-to-face interviews – These allow you to make observations while you are asking questions. For example, you can observe the client’s non-verbal communication to collect information about their feelings. Conducting a face-to-face interview can also help you establish rapport and develop a good working relationship with your client.
• Structured interviews – In these interviews you can follow set questions to collect information for norm-based assessment, where you are making comparisons of characteristics against statistical norms.
• Unstructured interviews – These can be used to gather detailed descriptive information about a client’s situation, experiences and feelings.

Questions That Empower

The way you structure and focus your questions can help to empower your clients by emphasising their capacities, skills and resources.

Here are some examples of empowering questions:

• Where do you find support in your life?
• Who can you trust to talk to about this?
• Think about how you dealt with problems in the past. How did you decide what to do? How did you solve the problem?
• What resources do you have that could help with this situation?
• What can we do to help you deal with this yourself?
• Have you dealt with similar issues in the past? What did you do that worked well?

Written Questions (Questionnaires)

You can collect information for assessing clients’ needs by using a questionnaire. This is simply a set of questions that are written down.

A questionnaire can be administered by asking the client to fill it in themselves, or by you asking the questions and filling in the client’s answers for them.

Written questionnaires are often used when you want to compare the information provided by a number of different clients.

Intake forms are an example of how questionnaires can be used to assess clients’ needs.

Reporting Assessment Results

Reporting assessment results is an essential part of the assessment process. Depending on your industry sector and your organisation, assessment results may be reported in writing and/or verbally. Most organisations keep a written record of assessment results, as a hard copy, digital file or both. Some organisations and sectors are required to include data about assessment results in their reports to their funding bodies.

In some contexts, assessment results are presented and discussed at team meetings or as part of case conferences.

Remember that client consent should be obtained for disclosing or sharing information such as assessment results.

Assessment results must be:

• Accurate – Assessment results can have a significant impact on clients’ lives, so they must be reported accurately.
• Objective – Reporting assessment results objectively maintains fairness and avoids bias. It means that, instead of making assumptions and interpreting behaviours or responses, you must describe what you saw or what you heard.

A certain degree of subjectivity or interpretation and judgment is unavoidable in carrying out assessments, but backing up your interpretations and judgments with evidence contributes to objectivity and accuracy.

• Relevant – Information that you collect and report must be relevant to what you are assessing.
• Sufficient – It is important to report all the relevant information so that you provide sufficient information and evidence to identify and assess the client’s needs.
• Honest – Assessment results must be reported honestly, without fabricating, slanting or otherwise altering them.

Assessment Results Policies and Procedures

Policies and procedures for recording and reporting assessment results will vary across different industry sectors and organisations, but they all must meet and reflect legislative requirements for privacy, confidentiality, equity and non-discriminatory practice.

They must also reflect and meet relevant service standards.

Assessment Tools

An assessment tool is simply an instrument that is used to collect and record information. The type of instrument chosen will depend on factors such as the context for the assessment, its purpose, characteristics of the client being assessed, and practical factors. For example, it may not be appropriate to use a written questionnaire with a client who struggles with literacy; or a very structured interview in an informal setting or with clients who feel intimidated when asked direct questions.

As part of preparing for assessment, you must work with your client to discuss and explain the tools you plan to use, how they will be used and what you will expect your client to do. If your client does not feel comfortable with this, choose a different way to collect information.

Remember that assessment is a collaborative process

Assessment methods, processes and tools/instruments must be:

• Valid – This means they must be appropriate and assess what they are intended to assess. For example, scales assess or measure weight—a tape measure would not be a valid instrument to assess weight.
• Reliable – This means that you must be able to trust the results. For example, if you weigh yourself three times at five-minute intervals and get thee different results, your scales are probably not reliable.
• Sufficient – This means that you must collect enough evidence or information to make a judgment about what you are assessing. Sufficiency means that you must have all the relevant information so that you can make a reasonable, accurate decision.

Assessment processes and instruments must be tested to ensure that they are valid and reliable so clients’ needs are assessed fairly, holistically and accurately.

Reliability

There are several ways to test an assessment instrument to see if it produces reliable and consistent results:

Test-Retest Reliability

This involves using the same instrument twice with the same group of individuals. If the results are similar, this indicates reliability. If the results are very different, the instrument is not reliable.

Parallel Reliability

This involves using different versions of the same instrument and correlating the scores or results to evaluate its consistency.

Inter-Rater Reliability

This involves asking two different assessors to use the same instrument so you can measure how consistent and how close the results are when different assessors conduct assessments.

Internal Consistency Reliability

This involves checking and evaluating how consistently different items (such as different questions) that target the same thing produce the same responses or results.

Validity

Validity refers to how closely the results of an assessment correspond to what is being assessed, or how relevant the information collected is to what is being assessed. For example, if you are assessing a client’s communication skills, is information about their accommodation relevant? A valid assessment instrument is one that measures what it is intended to measure. For example, if you want to know how tall you are, you would not use a set of scales, because scales do not measure height. You would use a tape measure or something similar.

Validity also includes using assessment instruments that suit the client’s characteristics and functional ability. For example, do not use a written questionnaire to collect information about a client’s attitudes or perceptions if the client struggles with literacy, because the client’s limitations will influence the results.

Conducting an assessment is similar to carrying out research. Preparation is an important step in this process.

Here are some points to consider when you are preparing for an assessment:

1. Check your organisation’s assessment policies and procedures and make sure that you understand your own role and responsibilities, and the steps you should follow.
2. Check existing records and information about your client, from your own organisation, other agencies involved and records provided by the client.
3. Seek additional information from sources such as family, carers, other service providers, and advocates.
4. Organise the practical aspects of conducting the assessment, for example:

Location/venue

• Is it suitable? Look at privacy, the physical environment, facilities, equipment and other resources available.
• How will your client get there? How accessible is the venue?
• How will you let your client know about the venue and the time required to do the assessment?

Materials required

• What assessment tools do you need?
• Are you familiar with how to use them?
• Are they appropriate? Why?
• What other materials are needed? Why?
• How will you record the information you collect during the assessment?

Environment set-up

• What activities are involved in the assessment? Is the environment suitable for the activities?
• What furniture is needed? How should it be arranged?

The assessment processes

• How will you obtain informed consent?
• How will you explain the nature and purpose of the assessment?
• How will you explain the procedures to be used?
• How will you communicate with your client?
• What skills will you use to encourage and support your client to express their goals, needs and preferences?
• What skills or strategies will you use to collaborate with your client?
• What can you do during the assessment to empower your client and support them to make informed choices and decisions?

Case Study

Raadhiya and Daphne

Raadhiya works in a residential aged care facility. She has been asked by her supervisor to assess the needs of a new resident, Daphne Smith, in the areas of physical and mobility support, memory and communication. Daphne has been referred for a respite stay.

Raadhiya reviews her organisation’s assessment policies and procedures and notes that, where memory and communication problems are identified, the resident should be referred for a specialist dementia assessment and diagnosis.

She then reads Daphne’s intake information and existing records and finds that Daphne’s family have been concerned about her memory lapses and communication difficulties for some time. Her medical records also show that her GP has been concerned about possible early dementia and has requested specialist cognitive assessments.

Other information in Daphne’s medical records show that she has advanced osteoarthritis in her hands, knees, hips and lower back; and has difficulty moving around. At home she uses a walking frame and an electric lift chair. She has also been diagnosed with mild osteoporosis and is being treated with vitamin D and calcium supplements.

Raadhiya arranges to visit Daphne in her room after Daphne has had time to settle in so Raadhiya can discuss and explain the assessment purpose and process, and obtain Daphne’s consent. Raadhiya brings with her some mobility aids, such as walking frames and sticks, for Daphne to try as part of assessing her mobility and physical functioning. She plans to show Daphne around the facility and observe how she moves, what supports she needs and what areas and activity she finds challenging.

Raadhiya has previous training in conducting simple memory tests. She gathers some assessment tools used in diagnosing cognitive and memory issues. She plans to use informal discussion and chat to observe Daphne’s communication skills and has prepared a simple checklist to structure her observations.

Raadhiya chats with Daphne about her family, her home and the activities that she enjoys. She notices that Daphne sometimes struggles to find the right word and often uses ‘thingamajig’ to describe objects whose name she has forgotten, and that she sometimes cannot answer questions about recent events.

After Raadhiya has carried out some initial observations and assessments, she plans to meet with Daphne and her family to gather more information about her support needs and preferences.

After the assessment and the family meeting, Raadhiya and her supervisor meet with Daphne and her family to ask them for feedback about the assessment process and the services and supports that have been identified to meet Daphne’s needs.

Daphne says she found the information Raadhiya provided very helpful and that she enjoyed being shown around the facility. She also said she found Raadhiya very sympathetic and friendly and that she felt comfortable with her.

Daphne’s family members raise some issues that were not addressed in the assessment, including Daphne’s occasional loss of balance due to vertigo, and asked that falls prevention strategies be implemented, especially when Daphne is moving around the facility and in the gardens. They are pleased with the plan to refer Daphne for more specialised assessment to address her memory lapses and communication difficulties.

Evaluating assessment processes is part of good practice and contributes to continuous improvement.

Evaluation is another form of research that follows much the same principles and steps as assessment. It involves collecting information about the assessment itself and may also include monitoring the outcomes of the assessment, for example, what services were provided as a result of the assessment and how successful they were.

Client Feedback

An essential source of information about assessment processes is feedback from your client. This means observing your client’s behaviour during the assessment, as this can provide valuable information about how the person is feeling; and taking time to discuss the process with them after the assessment.

Seek feedback about your own performance and how you conducted the assessment. This is something you may discuss with your supervisor.

You can use formal or informal questioning to collect feedback.

Outcomes

Evaluating the outcomes of an assessment is also important.

• What needs were identified and prioritised?
• What services are available to meet these needs?
• What does the client think/feel about the outcomes?
• How will the outcomes be followed up?

Reporting and Consulting

Depending on the context for the assessment and your job role, you may need to report the assessment results, feedback and outcomes; and consult your supervisor to discuss what you discovered, including feedback about your own performance.

In conclusion, this topic has delved into the vital role of assessing clients' service needs in the realm of community services.

Recognising the diversity across industry sectors and organizations, the discussion has outlined broad principles and examples of assessment methods. It emphasizes that specific policies, procedures, and tools may vary and that organizations will provide pertinent information.

The covered topics include an exploration of different types of assessments and their contextual applications, the overall assessment process, methods of information collection, the preparation for assessments, and the evaluation of assessment and referral processes. Armed with this knowledge, community service workers can navigate the intricacies of assessment, ensuring a comprehensive and tailored approach to addressing the diverse needs of clients within their unique contexts.