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The Camberwell Assessment of Need as an outcome measure in routine mental health care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
2006 (English)In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 41, no 9, 728-733 p.Article in journal (Refereed) Published
Abstract [en]

Background. Subsidiary findings in several studies indicate that the standard summary scores (total number of needs, met needs and unmet needs) of the Camberwell Assessment of Need (CAN) may conceal important differences among patient populations at the item level of the measure. The aim of this study was to investigate whether changes in need and need status at the item level are adequately reflected by changes in the summary scores. Methods. In a longitudinal design assessments of need in 1997 and 2003 of 192 outpatients (mean age 45.4 years, 78.1% psychotic disorders) in routine mental health care were compared. Results. None of the summary scores changed between 1997 and 2003. This result, however, was contradicted by significant changes in needs at the item level. Conclusions. The summary scores conceal changes in need on the underlying items and thus is recommended not to be used as dependent measures when comparisons among populations or between points in time are of interest.

Place, publisher, year, edition, pages
2006. Vol. 41, no 9, 728-733 p.
Keyword [en]
needs assessment, outcome measures, mental health care, rehabilitation, severe mental illness, psychotic disorders
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-96713DOI: 10.1007/s00127-006-0084-9ISI: 000240432800008PubMedID: 16775754OAI: oai:DiVA.org:uu-96713DiVA: diva2:171380
Available from: 2008-02-14 Created: 2008-02-14 Last updated: 2011-06-16Bibliographically approved
In thesis
1. The Camberwell Assessment of Need as an Outcome Measure in Community Mental Health Care
Open this publication in new window or tab >>The Camberwell Assessment of Need as an Outcome Measure in Community Mental Health Care
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 55 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 310
Keyword
Psychiatry, needs assessment, outcome measures, mental health care, health service evaluation, severe mental illness, psychotic disorders, Psykiatri
Identifiers
urn:nbn:se:uu:diva-8439 (URN)978-91-554-7085-2 (ISBN)
Public defence
2008-03-06, Föreläsningssalen, Museum Gustavianum, Akademigatan 3, Uppsala, 13:15
Opponent
Supervisors
Available from: 2008-02-14 Created: 2008-02-14 Last updated: 2011-01-12Bibliographically approved

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Wennström, ErikWiesel, Frits-Axel

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