<p>The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time.</p><p>We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care.</p><p>A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large.</p><p>In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.</p>

The overall aim of this thesis was to describe (1) needs for occupational therapy among persons with self-perceived activity limitations and/or participation restrictions due to long-term/recurrent pain, and (2) treatment interventions in occupational therapy to meet demonstrated needs. The Liss’ model for assessing health care needs was used as a structural scheme. A randomly selected sample (n=10,000) from the Swedish general population aged 18-58 years was the foundation for the study population with and without pain. In addition, occupational therapists were included (n=109). Data collection was made by postal questionnaires. The results showed a prevalence of 26 % and an incidence rate of 0.07. Demographic characteristics of the sample were female gender, ages 40-58 years and fewer years of education than those without pain. Pain in shoulders/lower back of searing/aching/gnawing character was the most frequently reported. A majority of the respondents reported affective/emo-tional effects of pain mainly of depressive character and they had previously been on sick leave due to pain. Women reported higher frequencies of self-perceived activity limitations/ participation restrictions due to pain, more difficulties with intermediate ADL, perceived higher job demands and had longer sick leave than men. Men perceived poorer social support than did women. Needs for occupational therapy were reported mainly as a consequence of activity and temporal imbalance. High health care consumers reported higher frequencies of needs/problems than did low health care consumers. The main goals and interventions suggested by occupational therapists to meet the needs in pain management focused on increased knowledge of handling daily occupations with the purpose to reduce pain, maintain competence/improve performance of home maintenance, reduce consequences of pain and increase knowledge how to handle effects of pain.

The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time. We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care. A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large. In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.

Uppsatsen undersöker via fem intervjuer hur biståndshandläggare resonerar kring ett biståndsärende gällande hemtjänstinsatser i äldreomsorgen och hur de motiverar sina bedömningar och beslut. Intervjuerna har företagits på biståndsenheten i Östersund i Jämtlands län. En vinjett som beskriver ett påhittat biståndsärende har stått som utgångspunkt för alla intervjuer och en fenomenologisk hermeneutisk analysmetod har använts vid framtagandet och tolkandet av resultaten. Resultaten som framkommit i studien antyder att biståndshandläggarna i Östersund tenderar att se till både sociala, fysiska, medicinska och psykiska behov hos kunden vid biståndsbedömning. När det kommer till gränssättning av hemtjänstinsatsers omfattning tenderar handläggarna också att vara relativt generösa i sina bedömningar. Hur gränserna sätts verkar emellertid vara något otydligt, delvis eftersom de inte har hjälp av några fastställda riktlinjer och att begreppet skälig levnadsnivå är så pass svårdefinierat. Förslag på framtida forskning, som ges i uppsatsen, är dels att utreda om det stämmer att biståndshandläggarna i Östersund är lika bra på att se helhetsbilden vid biståndsbedömning som studiens resultat föreslår. Att mer noggrant undersöka hur socialtjänstlagens begrepp skälig levnadsnivå tolkas av biståndshandläggarna – och hur det påverkar dem i deras bedömningar – är också ett förslag till vidare forskning. / Through five interviews the essay examines how care managers reason about a case concerning home help services in elderly care and how they motivates their judgments and decisions. The interviews have been undertaken in the city of Östersund in Jämtland. A vignette describing a fictitious case has been the starting point for all interviews and a phenomenological hermeneutical analysis has been used in the producing and interpretation of the results.                       The results emerging from the study suggests that care managers in Östersund tend to look to both the social, physical, medical and psychological needs of the customer when making their decisions. When it comes to setting boundaries of home care interventions the care managers also seem to be quite generous. How to set the boundaries does however appear to be somewhat unclear, partly because they do not have the help of established guidelines and that the concept of decent standard of living (skälig levnadsnivå) is so difficult to define. One suggestion for future research that is proposed in the paper is to investigate whether it is true that care managers in Östersund are as good as it seems to see the big picture of customers needs as the study suggests. Another suggestion is to more closely examine how the concept of decent standard of living is interpreted by care managers and how it affects them when they make their judgments and decisions.

The purpose of this study was to answer the following question: What was the perceived value to planners of incorporating information from ecotourists about their perceived needs in the standard system presently being used to plan interpretation? The Ecotourist Needs Assessment (ETNA) process was proposed as an external needs assessment. To exemplify this process, an instrument called Ecotourist Needs Assessment Instrument (ETNAI) was developed to collect input from ecotourists who visited the Malheur National Wildlife Refuge. A case resulted from the process. The ETNAI case was used to obtain planners' opinions about whether ETNA had value in the context of data collection and inventory in interpretive planning. The ETNAI case included developing and validating the ETNAI and providing a procedure for implementing ETNAI. Upon completion of the ETNAI case, an interview guide was developed and administered to interpretive planners. Interpretive planners were asked how they currently plan interpretation and collect information to decide interpretive topics. Other questions dealt with their feelings regarding the usefulness of the ETNA and the data collected using the ETNA. The interpretive planners described the current system and provided information about the proposed system (ETNA). Currently, decisions involving interpretation are based on three factors: 1) money, 2) mandates/missions, and/or 3) management. The interpretive planner chose outside (external) groups except during a master planning process when the general public provided input. The outside groups included: professionals, the public, and recreation providers. The current methods used to collect information were informal or considered casual. When contrasted with the proposed method, the interpretive planners felt the ETNA had value. This was reflected in their suggestions for use: As an evaluation tool after an interpretive program is given to a specific audience. As a method to assess the interpretive needs of visitors and specific audiences for interpretation. As a technique to access visitors and the public, both general and specific. As a mechanism to collect data at public meetings. As a systematic routine to develop interpretation, to provide feedback for further development, and to evaluate interpretation embedded in the site system. As a method to effectively determine the distribution of funds. / Graduation date: 1993

The purpose of this study was to examine the English language needs of Tour Guidance students of Faculty of Applied Sciences at BaSkent University by referring to the perceptions of students, English instructors and curriculum coordinators and to see whether there was a relationship between students&amp / #8217 / attitude towards English language and their self ratings of learning and target needs. The data collection instruments used for the study were the attitude scale and student needs assessment questionnaire administered to forty-five students, ESP Identification Form administered to two curriculum coordinators and English Instructor Questionnaire administered to both of the curriculum coordinators and the three English instructors. The descriptive analysis of the data revealed that there were both similarities and differences among the perceptions of students, English instructors and curriculum coordinators with respect to the learning needs and target needs of students. Paired-Samples T Test results indicated need for most of the skills referring to learning and target needs. The relationship between students&amp / #8217 / attitude towards English language and their self ratings of learning and target needs came up to be of different values for the seven subdimensions of attitude. On the basis of the results of the study, it is suggested that speaking, listening and specialist vocabulary be emphasised more in order to fulfill the ESP needs of Tour Guidance students. Applying skill based syllabus as primary and situational and content approaches to syllabus design as subordinate is suggested to be effective as well. Using instructional materials appealing to the subdimensions of attitude is another suggestion presented.

This document is a review of literature on needs assessments and the benefits of conducting one. Communicare is a mental health agency that serves the Lincoln Trail Region. Currently, most of the revenue from their children programs comes from Medicaid, which is a fee-for-services payer source. The Kentucky Medicaid Program is in the process of contracting with managed care organizations to oversee services that have been paid directly from Kentucky Medicaid. With these changes, mental health organizations must identify specific community service needs as well as expanding revenue sources. Applying for grants is one way mental health agencies can expand revenue sources. Communicare has identified the KY SEED grant that focuses on prevention and providing services to early childhood programs as a potential funding source. A needs assessment was conducted to gather information on children services implemented by Communicare. It was conducted in order to assess current programs and seek out potential areas of future program growth. The needs assessment further sought to identify gaps in services for the early childhood programs and assist in the grant application process. A review of existing data on children’s services offered at Communicare, including a satisfaction survey and a System of Care Assessment Report, was conducted as part of the needs assessment. A Community Forum with community partners from the Lincoln Trail region was held to gather additional data for the needs assessment.

We assessed how estimates of need-expected inpatient hospital use differ depending on whether need-expected use was estimated for a population of all Canadians, Canadian health regions, or a subpopulation of higher income Canadians, who likely had minimal healthcare access problems. Data came from the 2009/2010 Canadian Community Health Survey, a national cross-sectional survey. Using zero-inflated negative binomial regression, we modeled inpatient hospital use separately based on the three aforementioned choices of population. We adjusted for demographic, health behaviour, health status, socioeconomic, and health care supply factors. We then estimated need-expected inpatient hospital use and compared the estimates across individuals and by income and province. The three choices of population that we used in this study had similar results. Our estimates of the average need-expected use by province or income group were not sensitive to the choice of population used to estimate need-expected use.

This inquiry explored the everyday struggles of several women who worked as coordinators and instructors in three government-funded job-entry programs for women in the non-profit sector. The programs studied included an entry program for native women, a program which trained immigrant women in bookkeeping skills, and a program which trained women on social assistance to enter the construction trades. The work of the staff in these programs was considered in light of a theoretical framework developed by Nancy Fraser. Fraser has called for a different approach -- a more critical discourse-oriented inquiry -- to the study of social-welfare policies and programs. This approach focuses on the political struggle over the interpretation of needs, particularly women's needs, which she sees as central to social-welfare policy-making. In her study of the American system, she has found that "needs talk" is the medium through which inequalities are symbolically elaborated and challenged. She also has found that needs talk is stratified and differentiated by unequal status, power, and access to resources, and organized along lines of class, gender, race, ethnicity and age. For this study, information was collected through interviews with the staff in the three programs, observations of life skills classes, and examination of program proposals. Government and government-related documents were also examined. The analysis revealed that, in the official policy documents at the national level, women’s needs were interpreted within a dominant policy framework which focused on reducing spending, matching workers to the market and privatizing training programs. Programs for women were developed based upon a "thin” understanding of women's needs -- one which focused on women’s lack of training and job experience and ignored the structural inequalities of the labour market and women’s different racial and class struggles. At the local level, analysis of the interviews, observations and documents indicated that the staff struggled to respond to the trainees' diverse and complex needs which the official policy discourse addressed in only a limited way. In their negotiations with the state, the staff employed a plurality of needs discourses, engaging in a process which both challenged and reproduced the dominant policy orientation toward getting women "jobs, any jobs”. There were moments of resistance by the staff to the dominant policy orientation, most notably in the program for native women. The trainees also challenged the narrow interpretation of women's needs, particularly in the program training women to enter the construction trades. Generally speaking, the analysis indicated that the staff played a crucial role in mediating between women and the state and in producing a kind of discourse which tended to construct the trainees as subjects needing to be "fixed". The analysis also revealed that the relationships between staff, trainees and the state were organized around unequal access to resources based on gender, race and class. In order to transcend the limitations outlined in this study, efforts are required to democratize decision-making, collectively organize the non-profit private sector, challenge privatization and the exploitive practices of the state, and bring alternative approaches which support participatory and dialogical processes of need interpretation. The analysis brings to light the importance of studying the implications of state policies on adult education practice, particularly policies which promote privatization. It also reveals the explanatory power of a feminist theoretical framework which provides a more critical, discourse-oriented approach to examining policy and practice, and the usefulness of this framework for further research and political advocacy.

Tuberculosis is one of the deadliest communicable diseases in the world, and consequently remains one of the biggest global healthcare challenges. Tuberculosis is treatable and curable. However, within many low resource settings, underdeveloped medical infrastructure limits the effectiveness and accuracy of existing diagnostics. These limitations severely impede the timely diagnosis of the disease, and thus contribute to the disease spreading, developing drug resistance, and killing more individuals. There is an urgent need for an inexpensive, portable, rapid, easy-to-use point of care diagnostic that can function outside of the laboratory at the community level. Currently, there is a wide range of available tuberculosis diagnostics ranging from sputum smear microscopy to nucleic acid amplification tests. Yet, none have met every standard of the ideal point of care diagnostic. Since the World Health Organization’s endorsement of Xpert MTB/RIF in 2010, there has been a resurgence of interest in point of care diagnostic development. This investigation reviewed diagnostic development projects funded by the National Institutes of Health in 2008 and 2014 in order to examine the technologies being developed, how researchers in industrial and academic sectors are addressing this problem, and what challenges still need to be overcome. More projects in 2014 were expected to rely on sample types other than sputum and be funded than those in 2008. The results of this investigation confirm this hypothesis, and that the development of a point of care device is a multi-faceted challenge with numerous underlying issues that need to be addressed before such a device can be successfully implemented.