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Needs Assessment: A Practical Guide to Assessing Local Needs for Services for Drug Users
Chapter 2: Using Existing Sources of Information
Needs assessment involves the collection of data from a number of sources. In some cases, the data will already exist, in the form of
routinely collected data sets, the
results of local population surveys, and
published or unpublished research papers. Other information will have to be collected through, for example, focus groups or one-to-one interviews with practitioners and members of your target population. This chapter focuses on the identification and use of existing sources of information as a starting point for needs assessment. Later chapters will discuss methods for collecting new information.
The aim of data collection is to
build up a picture of the overall size and nature of the group's needs. No single source of information will be able to give you the total picture, but several sources taken together should give you different pieces of the puzzle. While it is unlikely that you will ever be able to measure a particular group's needs perfectly, you can get a clear idea of the overall picture without having all the puzzle pieces. Your effort should be spent in gathering
enough information to see the picture, not in gathering
all the information that is available (Scottish Needs Assessment Programme, 1998).
Existing data sources include those that are collected 'routinely', and those collected for a project or, a specific 'one-off' purpose. Examples of routinely collected data include: data from the individual assessment process, data on drug users in treatment held by the Information and Statistics Division (from SMR24 forms), and data on deaths held by the General Register Office for Scotland. Project data may come from studies carried out by local NHS Boards or universities, and from some national surveys and censuses. For example, the study to estimate the national and local prevalence of problem drug use is an important source of information about the size of local drug using populations (Hay et al. 2001).
You can use existing sources of information to produce a
profile of your population. Existing sources of information may be able to help you answer a number of questions about your population. Some of these are shown below.
Key Questions to Ask of Existing Sources of Information How big is the target population? What do they look like? For example, what is their age profile? How many of them are male and how many are female? What do we know about their drug-using behaviour (e.g. when did they start using drugs, how long have they used drugs, and what drugs do they use)? Are they generally in employment or unemployed? Where do they live? Who do they live with, e.g. dependent children? Are they already in contact with services, or are they "hidden" from existing services? With which services are they in contact? How often do they use services? Which groups use which services? What interventions are most effective for this population?
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There are some "health warnings" about the use of existing information. No source is likely to be able to tell you exactly what you want to know about your target population. In fact, information from different sources may give contradictory answers to your questions, if the questions are addressed by the data at all. Furthermore, not all sources of information will be robust enough to give you accurate data about your population. All of these issues should be considered carefully before deciding which information sources to use in your needs assessment, and what weight to give the information.
Remember, these data sources were not originally collected to answer your local needs assessment questions.
The following principles may be helpful when deciding which sources of information to use:
Be selective. Don't refer to sources of information or data that are not directly relevant to your target population. For example, data from a survey on the prevalence of recreational drug use among young people in Glasgow is unlikely to say very much about young people's needs for treatment in Orkney, although it may be more relevant to young people's needs in Edinburgh.
Advice "There is a risk that large amounts of data are gathered but no one knows what it actually means. It is a good idea to know what you want out of the data before you start to collect it."
(Scottish Needs Assessment Programme 1998). |
Find out why the data were originally collected. Knowing the aim of the original study will help you decide how much weight to give to the results for the purposes of your needs assessment. The data will have more value if the aims of the original study are closely related to your own aims.
Consider the strengths and weaknesses of the information. This will help you decide the extent to which the information can be generalised to your target population. For example, is the information based on a large study undertaken 20 years ago? This may be of less value than information from a smaller study undertaken 6 months ago.
The purpose of this exercise is not simply to gather data. The
data will need to be analysed, interpreted and summarised in order to answer the following question:
What does all this information tell me about
the needs of the target population?
Appendix 2 of this guide provides details about some sources of existing information that can be used in a needs assessment. It is by no means a comprehensive list, but these information sources can provide a helpful starting point. In the section below, we offer some additional explanation of two particularly useful sources of information:
Survey data
The results of population surveys are useful for giving a rough estimate of the size of a problem in a particular population at a specific point in time. For example, the Scottish Crime Survey is a survey of a nationally representative sample of individuals living in Scottish households. It provides an index of crime in Scotland which complements the official police crime statistics by estimating the extent of crimes experienced by people, whether or not they are reported to or recorded by the police.
It is important to be aware that the results from household surveys may underestimate the size of the subject you may be most interested in, particularly if this subject is related to behaviour that is closely linked to criminality, vulnerability, lack of education or poverty. Many people with such problems will simply not complete the survey form, or they will be unable to do so (i.e., they have reading difficulties, are homeless, in hospital or in prison). Surveys that are specifically targeted at "hidden" populations are often more reliable in their findings about those populations than general household surveys.
Use of data from individual assessment
The assessment of the needs of individual service users provides an important source of information for a local area needs assessment (EIU 2002a). An effective assessment process will identify the needs and aspirations of the individual and inform decisions about treatment, care and support. It should lead to the development of an Action Plan agreed by the service provider(s) and the individual. It may be that not all the identified needs can be met by the services currently available. In this case, it is important to have arrangements in place to capture information about the gap between the optimum service, or package of services, and the actual provision that can be delivered. That gap represents the
unmet need.
Example Forth Valley Substance Action Team (SAT) have been pro-active in encouraging service providers to increase the priority they place on data collection and analysis. A Minimum Dataset has been developed locally, and services have been given the necessary software and training to use it. On the back of this, the SAT is using Geographical Information System (GIS) software to enable data to be compared and analysed across services and within a service. This allows specific gaps in service provision to be identified and also provides a useful perspective on how well service provision is being targeted in particular geographical areas. The investment in obtaining standardised reliable, postcoded data means that the SAT is able to undertake statistical analysis to explore correlations between data sets. For further information contact Marion Logan:
marion.logan@fvhb.scot.nhs.uk |
When that information is
regularly and systematically recorded, and then aggregated, it provides a unique contribution to the needs assessment process. The essential first step is that it comes out of a
comprehensive assessment and action planning process. It is then particularly valuable because it will give a robust picture of unmet need and gaps in services based directly on the assessed needs of service users. It also means that this information is part of
day-to-day activity and does not, therefore, require a major investment of time and resources to feed into a separate needs assessment exercise. To make this process work requires:
an effective assessment process;
regular and systematic recording by service providers of the shortfall or gap between the "ideal" service(s) for the individual and what can be provided at present;
mechanisms for service providers to regularly report this information to the DAAT and partner agencies to inform service planning and the (ongoing) needs assessment.
The use of assessment tools can help provide a structure for the recording and reporting of the information gleaned through the assessment process. Further information about assessment tools may be found in the publication, 'Digest of Tools Used in the Assessment Process and Core Data Sets' (EIU 2003a). The EIU 'Evaluation Guide 7: Using Assessment Data for Evaluation', also offers relevant advice and information (see EIU 2002b).
Example Children in the Borders affected by substance misuse in the family Between Nov 2002 and Feb 2003, Borders Drug and Alcohol Action Team gathered information from several sources to get an estimate of the prevalence of children affected by family substance misuse. Sources of existing information included: data from the Social Work Department information from the Scottish Borders Child Protection Register assessment data from the Big River Project (a drugs outreach service in the Borders, managed by Turning Point Scotland) Borders-specific findings from the research study, The National Prevalence of Problem Drug Misuse in Scotland (Hay et al. 2001) annual statistics from the Information and Statistics Division on alcohol-related problems and alcohol-related deaths in the Borders the findings from a previous survey of local GPs by Scottish Health Feedback (1997). (Source: Murray & Hogarth 2003)
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Data protection
The Data Protection Act 1998 governs the use of personal data held on computer or paper. The use of personal information for needs assessment must comply with this legislation. According to the Act, information generated by an individual assessment would fall within the category of 'sensitive personal data'. Sensitive data cannot be processed or shared with other organisations unless certain conditions are met, including obtaining the explicit consent of the data subject. This can be done easily by explaining to the individual when the data are collected, how they may be used. If the information is used for additional purposes, this will need to be explained to the individual at the appropriate time and when they are able to make sense of it. It may be unnecessary to obtain consent from individuals if their information is
anonymised before using it.
Most statutory bodies now employ
Data Protection Officers, who will be able to provide advice regarding the use of personal information for needs assessment and service planning purposes. In addition, all NHS organisations have a member of the senior medical staff who acts as a
Caldicott Guardian. Caldicott Guardians are responsible for safeguarding and governing the uses made of patient identifiable information, both clinical and non-clinical, within the NHS. A list of Caldicott Guardians is available at:
http://www.show.scot.nhs.uk/confidentiality/publications/caldicottcontacts.htm. The EIU has provided practical guidance to DAATs and partner agencies on information sharing in 'Integrated Care for Drug Users' (EIU 2002a).
Evidence on effectiveness
If you want to find out the best way of introducing a new service, or a new intervention into an existing service, your needs assessment exercise should involve looking at the evidence on effectiveness. This evidence is available through a number of sources, including reports of research studies, government policy documents, and the published research literature. You can access information about published research articles through bibliographic databases such as Medline, PsychInfo, or Embase. The EIU has published a number of research reviews on effective interventions. These are available from the EIU website. The NHS Scotland elibrary, available to all NHS employees at
http://www.elib.scot.nhs.uk/ and the Cochrane Library, available at
http://www.nelh.nhs.uk/cochrane, are also useful sources of information. If your organisation employs a librarian, this person will be able to give you advice and assistance in conducting a literature search.
THINK ABOUT |
When gathering information about your target population from existing data sources, think about: What this information tells you about the needs of your target population What the strengths and weaknesses of the information are Whether you need to consult with a Data Protection Officer before using or sharing personal assessment data for the needs assessment What the most effective interventions for your target population are
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