Assess and provide Services for Clients with Complex Needs Overview Cluster 2 material Diploma Case Management

Complex Needs ‘Complex needs’ is a term commonly used across health and welfare sectors. Sometimes used interchangeably with terms such as ‘challenging behaviours’, ‘multiple needs’ and ‘multi service clients’, ‘complex needs’ is increasingly used by service planners and providers as well as policy makers to refer to people whose needs and behaviours challenge health, human services and criminal justice systems.

Complex Needs PEOPLE IDENTIFIED AS THOSE WITH DEFINED COMPLEX NEEDS ARE ADOLSCENTS AND ADULTS WHO MAY PRESENT AS: EXPERIENCING COMBINATIONS OF MENTAL ILLNESS, INTELLECTUAL DISABILITY, ACQUIRED BRAIN INJURY, BEHAVIORAL PROBLEMS FAMILY DYSFUNCTION AND DRUG AN ALCOHOL ABUSE. THE SUPPORT THEY REQUIRE DRAWS ON SIGNIFICANT RESOURCES AND MULTI AGENCY RESPONSES AND PROCESSES.

Key Service Providers Disability, housing, child protection, juvenile justice, mental health and drug treatment services, as well as components of the criminal justice system, are key service providers to this target group.

Service Responses and Challenges DE-INSTITUTIONALISATION REFORMS IN THE 1980’S LED TOWARD COMMUNITY BASED TARGETED AND SPECIALISED SERVICES. LACK OF PLANNING AND RESOURCES TO MEET THE NEEDS OF PEOPLE WITH COMPLEX NEEDS. DEMANDS FOR SPECIALISED COMMUNTIY BASED AND HEALTH SERVICES HAVE INCREASED WITH LIMITED GROWTH FUNDING BY GOVERNMENT. MORE FUNDING IS NEEDED FOR SOCIAL SUPPORT AND RESIDENTIAL SERVICES. INCREASED FOCUS ON COMMUNITY CARE AND COORDINATION BETWEEN SERVICES

Defining the Problem(s) Clients usually come to a service with some idea of what their problem is. This is usually known as the ‘presenting’ problem. Where complex assessments are required, the number and nature of issues may be many and varied. In the process of developing a relationship with a client, you may find that the client has a range of problems that are related, either directly or indirectly, to their presenting problem. For example, “John” may come to your service because he is having difficulty holding down a job or because he is having relationship problems with his partner. During your discussions with him, you may discover that these problems are related to his drinking problem. You might also discover that he sees his drinking problem as a result of the difficulties he is having at work. Regardless of what the presenting problem is, you need to gain a good understanding of how the client sees their problem or problems. Imagine that “John” has come to you for help with his problem. During the assessment process, what sort of questions could you ask him to gain an understanding of how he sees his situation?

Domain-based Assessment Domain-based assessments look at: the person’s acquisition and use of knowledge and skills (including early language/communication) at the level expected for his or her age the person’s social-emotional skills (including social relationships) at the level expected for his or her age whether the person uses appropriate behaviour to meet his or her needs at the level expected for his or her age. Domain-based assessments can measure attainment in the concepts of social standards.

Norm-based Assessment Norm-based assessment refers to the process of judging and grading a person’s achievement according to how well they have performed compared to a larger group. An IQ test is a good example of a norm-based assessment. One of the major issues of most norm-based assessment tools is the reliance on written or oral responses as they do not support alternative communication systems. Because the decision based on the assessment is extremely important for the person concerned, psychologists are usually involved in assessing both intelligence and adaptive behaviour. It is only if the person is assessed as having an intellectual disability that a range of services will be available.

Functional Assessment Functional assessment is about measuring the performance of, or capacity to perform, a variety of activities normal for people in good health. The Department of Ageing, Disability and Home Care (DADHC) uses a comprehensive set of endorsed assessment tools to diagnose level of disability in individuals. These tools include: internationally recognised psychometric intelligence scales developmental scales functional assessments non-verbal intelligence tests for people with more significant disabilities. All tests used by the Department are standardised and regarded internationally as effective tools in assessing the intellectual and functional abilities of an individual. The Department has an endorsed definition of intellectual disability that includes an individual's functioning in cognitive as well as physical domains. This is available in detail on the Department's website <www.dadhc.nsw.gov.au/DADHC.htm>. The level of disability is determined through the use of recognised psychometric tests and functional assessment.

Competency-based assessment Competency-based assessment is designed to measure performance, skills and knowledge against the standards for skills and knowledge needed in the workplace. Assessing competence is about finding out whether a person can use knowledge and skills to successfully complete activities. Activities for assessing workplace competencies need to be: assessed in a range of situations and environments completed according to the performance standard expected in the workplace. Characteristics of competency-based assessment Criterion-based assessment: The person is assessed against standard criteria or benchmarks. They are not assessed in competition with their peers. Evidence based assessment: The person being assessed may produce or demonstrate the evidence of their competence or the assessor may gather the evidence. Participatory assessment: The person being assessed is encouraged to be involved in the process of assessment. Both the person and the assessor have the scope to negotiate the form and range of assessment activities.

Case Study Kay is 18 years old and has been involved in the service system since she was a child. She has experienced long term abuse, neglect and abandonment. She has significant cognitive deficiencies and learning difficulties and limited capacity to control negative behaviours and violence toward others. Kay has been in a foster care environment since she was 9 and while their displayed some positive behaviours toward her foster mother, but not toward the children in the family. She acted out and was placed in out of home care accommodation, but no-one has been successful in managing her violence toward others. Kay has been diagnosed with substance abuse problems, intellectual disability, behavior disorders including indiscriminate sexually inappropriate behaviours. Kay is currently being supported in community care with 24 hour supervision to minimise her risk behaviours. The opinion of case managers is that she would be better placed in a therapeutic environment.

Practical Application to Kay What needs can you identify here? What information would you need to gather? Referring to the case study Kay, go through the list of broad topic areas identified for designing an assessment form and develop several questions that you think are relevant to the assessment for Kay. Role- play these in pairs and make a note of how ‘your client’ reacts to you. It would be interesting to find out: if they thought you were asking irrelevant or unnecessary questions if they thought the process was uncomfortable, too long or not long enough whether they felt that you gained a good picture of their life as a whole and a good grasp on what they see as their major problem. It would also be a good idea for you to reflect on how you felt asking all those questions. Were there any areas where you felt particularly invasive or uncomfortable? Why do you think you felt this way?