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Factors Associated with Changing Patient Needs in an Assertive Outreach Team

Rehabilitation Psychiatrist, Gloucester, UK, rob.macpherson{at}glospart.nhs.uk

Nathan Gregory

Gloucester AOT, Burleigh House, Eastgate Street, Gloucester, UK

Mike Slade

Health Services Research Department, Institute of Psychiatry, London, UK

Chris Foy

R&D Support Unit, Gloucester, UK

Background, aims: Although clinical use of needs assessment tools is widespread, there is little evidence about their value in longitudinal use. This study aimed to identify the factors associated with changing needs in an assertive outreach (AO) team's caseload, over a 6-month rating period.

Methods: The Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS) and the Engagement Measure (EM) were used to assess need and engagement with services respectively, in an AO team caseload. Care planning was based partly on awareness of current unmet needs. The patients were then reassessed at a 6-month follow-up, to determine to what extent identified unmet need had been successfully addressed, and whether levels of engagement had altered.

Results: Data were obtained for 79 of 82 patients on the AO team caseload. At 6-month follow-up patient-rated unmet need, but not staff-rated unmet need, was significantly reduced. Patient-, but not staff-rated met need was significantly increased. Measures of engagement were unchanged. Patients' needs changed across a variety of physical, social and psychological domains, rather than in one specific area. In regression analyses, only accommodation type was independently associated with patient-rated changing met need; only diagnosis was significantly related to changing patient-related unmet need.

Conclusion: In this study, the CANSAS was used routinely in a standard AO team, and the finding that over a 6-month period patient-rated unmet need reduced significantly suggests that formal rating of needs assessment may have helped to target care planning effectively.The results suggest that accommodation type and diagnosis may play an important role in the ability of services to effectively meet patient needs, but further work in larger samples is needed to address these questions.

International Journal of Social Psychiatry, Vol. 53, No. 5, 389-396 (2007)
DOI: 10.1177/0020764007078338


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