1. Embedding a Broader Needs Assessment
Changing Practice
Embedding a Broader Needs Assessment
Framework
Acknowledgement to Peninsula Health (demonstrated leadership in taking on this piece of work that has gone on to inform 2 local councils and their assessment frameworks) this was an unfunded piece of work
Julie White

2. Why?-Plan
Background
Acknowledges an identified need for a more holistic, coordinated and systematic approach to client care and a move away from the current problem-oriented/discipline-specific focus on health.
Adopting a holistic and sensitive approach to client needs in context of their physical, social, emotional and cultural environments
Supporting the transfer of care between settings to facilitate the provision of integrated care
Reducing assessment duplication
Integrating self management, health promotion & prevention within the assessment phase of the client journey
The Broader Needs Assessment does not replace clinically specific assessments however it aids in identifying the interrelated factors(social determinants) identified by the World Health Organisation that impact a client’s capacity to self-manage their chronic condition
Acknowledgement to Peninsula Health demonstrated leadership by taking on the area of assessment a piece of work that was unfunded
There are a number of good reasons for exploring the possibility of a standard comprehensive assessment approach for clients with complex and chronic conditions. These client groups are frequent users of health and aged services across the service spectrum and a standardised approach to comprehensive assessment would potentially be an important step towards the following:’
Achieving person and family centred care
Adopting a holistic and sensitive approach to client needs in context of their physical, social, emotional and cultural environments
Optimising self-management
Supporting the transfer of care between settings to facilitate the provision of integrated care
Ensuring that broader client needs are identified regardless of their entry point into the health system
Reducing assessment duplication
The potential to benchmark client groups and outcomes
Integrating health promotion & prevention within the assessment phase of the client journey
The Review and Identification of an existing validated comprehensive assessment tool. Final Report Oct 2004 A project undertaken by the Lincoln Centre for ageing and Community Care Research, Australian Institute of Primary Care and La Trobe University for the Department of Human Services
Ibid

3. Do-Getting the evidence to drive change
Benchmarked 11 assessment templates in community health against an existing validated assessment template
A medical record audit of 120 files was also undertaken with a focus on best practice chronic care e.g. does evidence based decision support drive the care pathway
Findings analyzed and benchmarked against Wagner Chronic Care /and Victorian Service Coordination Practice Manual.

4. Study 0% of assessment templates captured
depression and anxiety,
oral health,
transport issues,
financial concerns,
formal supports and
carer involvement
27.3% of assessments captured smoking and client identified needs
18.2% of assessments captured pain, nutrition and weight
9.1 % of assessments captured cognition and memory, falls, living arrangements and informal supports

5. Study-
Governance- Formation of working group-Key stakeholders from multiple settings and sectors were engaged. Department of Health Industry advisor/DHSV/ Acute Mental Health -key members of working group
Developed -Overarching principles aligned with National and State Policy directions
All domains sought clinical expertise aligned with evidence based practice and identified locally relevant pathways
Obtained consensus and agreement around question set to be trialed
Consumer input- we trialed question set with focus group and also utilized a mental health community advisory committee
Implement-ACT
Three month pilot across multiple services and settings e.g.
Koori / PenDAP / Mi Health / Early Intervention /HARP/ Domiciliary Care /Counselling

6. Study-Outcomes/ Evaluation
File Audit
Applicability and Practicality of the template questionnaire
Post pilot Focus Group
Consumer feedback
MENTAL HEALTH &WELLBEING
%that asked about domain prior
%asked about domain after BNA
Living Arrangements
52%
94.2%
Relationships
88.8%
Depression, Anxiety and Stress
50%
86.1%
Social Activities (isolation flag)
39 .5%
80.50%
Culture, Values and Religion 0%

7. Study- Domain %that asked about domain prior
%asked about domain after BNA
Medical Conditions 96.3%
75%
96.3%
Client stated issue (client centred care)
47.9%
86%
Monitoring Signs and Symptoms
29.1%
63.6%
Ability to get to appointments (transport)
6.25%
77.7%
Confidence at appointments
2.08%
77%
Medication management
27%
88.23%
Pain
48%
91.6%
Caring for others (carer strain) 8.3% 82% Cognition and Memory 25% 82.35% Falls 31.25% 88.57% Self efficacy 16.6 % 91.4 Eyesight 27.03% 94.2% Hearing 27.03% 93.75%
Sleep 16.6 % 87.8%

8. Integrating Self management into assessment
HEALTH RELATED
BEHAVIOUR
Domain
% of files that asked
about the domain
PRIOR to the BNA
template
WITH the BNA pilot
Oral Health
17.0%
87.87%
Smoking
31%
88.57%
Client importance and confidence
Of the clients who
answered yes to
smoking 7.1% asked
about client
importance and
readiness to change
smoking 53% asked
about client importance
and readiness to change

9. Collaboration-Shared Learning's & expertise
The Frankston Mornington Peninsula Primary Care Partnership-had identified through a large catchment wide scoping activity that Assessment was an area its partnership would like to focus on
A proposal was put fourth that the work undertaken by Peninsula Health could be shared and further roll out could occur across the catchment for a more consistent approach to assessment could be