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Deconstructing the 'black box' of the Camberwell assessment of need score in mental health services evaluation
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
2008 (English)In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 43, no 9, 714-719 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of the study was to examine an alternative way of scoring the Camberwell Assessment of Need (CAN) for the purpose of service evaluation, using the by us defined Social Services (SI) and Psychiatric Services (PI) subindices. Methods: CAN assessments in 1997 and 1999 of 262 outpatients (mean age 45 years, 77.1% psychotic disorders) were reanalysed to fit the SI and the PI, which were compared to the full CAN. Results: The mean total needs on the full CAN decreased from 6.65 to 6.22 (P = 0.007), as did the mean unmet needs (1.55-1.81, P = 0.049). The mean total needs on the PI decreased from 2.42 to 2.22 (P = 0.006), as did the mean unmet needs (1.66-0.57, P < 0.001). No changes in mean needs occurred on the SI. Conclusions: All significant changes occurred on the PI, indicating a more beneficial outcome of the psychiatric care than the social care in terms of meeting needs, a result impossible to discern from the total scores of the CAN. Thus, output scores on subindices of the CAN might be useful as outcome measures in service evaluation.

Place, publisher, year, edition, pages
2008. Vol. 43, no 9, 714-719 p.
Keyword [en]
Mental health care, Needs assessment, Outcomes measures, Services evaluation, Severe mental illness
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-96714DOI: 10.1007/s00127-008-0354-9ISI: 000259364000005PubMedID: 18427702OAI: oai:DiVA.org:uu-96714DiVA: diva2:171381
Available from: 2008-02-14 Created: 2008-02-14 Last updated: 2011-01-05Bibliographically 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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