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  • Commentary on "How Should We Measure Need?"
  • J. Morgan

Max Marshall's article raises some interesting points regarding the concept and practice of needs assessment. Marshall describes the limitations of the approach to needs assessment as embodies in the MRC Needs for Care Assessment Schedule and, more specifically, in the schedule's three-stage approach: (1) selection of area of functioning; (2) problem identification in that area of functioning; and (3) identification of needs from identified problems.

Marshall argues for the adoption of a four-stage process that includes a "criteria for action" stage. This stage incorporates the views of patients and caregivers and determines that action is required when the patient wants help, the problem is sufficiently severe, or the care-givers require help. Marshall classifies problems meeting these criteria as cardinal problems, this modified process is supposed to reflect what actually happens in clinical practice more closely than does the one-dimensional view of needs taken by the MRC schedule.

The concept of needs assessment is complex. Needs can be classified on the basis of who is defining the need; thus, the patient or caregiver offers views on needs ("felt needs"), and professional may define needs (professionally perceived needs). Felt needs may be expressed as demands on services or may remain unexpressed. There is often agreement or overlap between felt need and professionally perceived need, but there is potential for disagreement.

Professionals refer to an expression of need or a demand as appropriate when the felt need overlaps with professionally perceived need and as inappropriate when they do not feel they can offer acceptable treatment. Professionals may also identify hidden needs—needs not recognized by the patient or caregiver. Needs can also be classified on the basis of the service by which the need might be met: for example, psychiatric care.

Thus, the assessment of needs is complex and involves professionals, patients, and caregivers. It can be argues that all three parties should be involved in all stages of the assessment process that underpins the community care strategy. For example, when a forty-year-old man with depression is referred to a psychiatrist, the psychiatrist needs to talk to the patient's family as well as to the patient himself about his abilities and problems. They will jointly assess the problem areas and decide whether action should be taken in these areas. Finally, interventions will be agree upon providing the resources are available.

The key point here is that throughout the process there is negotiation and interaction. This has resulted in some agencies' adopting an individually focused "personal futures planning" approach (see, e.g., O'Brien 1987) in the need assessment process. Here the patient adopts a central role in an interactive process. [End Page 39]

The challenge for practitioners is to adopt sound clinical assessment and interventions based on good research. Any assessment tool developed must reflect an interactive process and enshrine the values and principles underpinning the service philosophy.

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J. Morgan
Consultant Psychiatrist in Learning Disability, Oxfordshire Learning Disability NHS Trust, Slade House, Horspath Driftway, Headington, Oxford, UK

Reference

O'Brien, J. 1987. A guide to lifestyle planning. In A comprehensive Guide to the activities catalogue: An alternative curriculum for youths and adults with severe disabilities, ed. B. Wilcox and G. T. Bellamy. Baltimore: Brookes. [End Page 40]
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