Camberwell Assessment Of Need Research Articles

Integrating unmet needs into dementia health-related quality of life research and care: Introduction of the Hierarchy Model of Needs in Dementia

Objectives: To make an inventory of needs assessment instruments in dementia, to explore the interaction between unmet needs and health-related quality of life (HRQoL) and to relate these to the conceptual model of Maslow's Hierarchy of needs in order to design a dementia-specific model. Methods: Narrative review of literature on (measures of) needs of patients and caregivers and HRQoL determinants important in dementia. Relating these needs to individual goal setting instruments and Maslow's Hierarchy of needs model. Results: The Camberwell Assessment of Needs for the Elderly (CANE) turns out to be a valid tool to assess needs of dementia patients, suitable for research and clinical use. The Carers’ Needs Assessment for Dementia (CNA-D) is a valid instrument to assess needs of caregivers. Patients identified significantly fewer needs than (in)formal caregivers. The most important needs, that also determine large part of HRQoL, are need for information; support with regard to symptoms of dementia; social contact and company; and for health monitoring and safety. Goal attainment scaling in dementia is an important but not yet valid outcome measure, with only few data on feasibility in dementia patients. Conclusion: There are several instruments to assess needs of dementia patients and caregivers. Domains of unmet needs and HRQoL overlap. The Hierarchy Model of Needs in Dementia (HMND) offers a new theoretical framework to address the interplay between meeting of needs and improvement of HRQoL in dementia. By identifying unmet needs in dementia-research and focussing on unmet needs in dementia-care, much can be done to improve HRQoL.

P01-374 - Needs of the elderly in polish and German rehabilitation centers

AimNeeds of the elderly are complex and difficult to identify since connected with many different dimensions. The aim was to identify met and unmet needs of patients referred to old age rehabilitation services in Poland (Wroclaw-Wr) and Germany (Hamburg-Ha).MethodsPatients (n=80) over the age of 60 were assessed using the Camberwell Assessment of Need for the Elderly (CANE), Mini Mental State Examination (MMSE), Global Deterioration Scale (GDS), Good Milieu Index (GMI) and Activities of Daily Living Scale (ADL). Patients were at least 2 weeks under rehabilitation due to orthopedic or neurologic reasons.ResultsBoth groups were similar concerning age, gender, education and marital status. Satisfaction of the ward was the same. Wr-patients were significantly more demented (25.1 vs.26.8; p=0.011), depressed (4.12 vs 3.0; p=0.033) and disabled (24.88 vs 76.62; p< 0.0001).The mean number of total, unmet and met needs before rehabilitation was similar in both centers. However, significantly more needs in accommodation, eyesight /hearing /communication and benefits were reported in Wr, whereas psychological distress and food in Ha.During rehabilitation program over twice more unmet needs were reported in Wr vs. Ha (1.38 vs. 0.57; p =0,0029) in the areas of eyesight /hearing /communication and benefits, continence, money.Ha received twice more formal assistance than Wr before (0,0027), but Wr twice more during rehabilitation (p< 0,0001).Assessing individuals needs may help in creating individual complete rehabilitation program within continuing care post discharge and improve quality of life.

The sexual and relationship needs of people who experience psychosis: quantitative findings of a UK study

Few studies have investigated the experiences of people regarding sexual and relationship issues in the area of mental health. This study presents the quantitative findings of a larger study that was conducted in London, UK. The aims of the study were to establish client's sexual and relationship experiences and perceived needs. A total of 30 people with a medical diagnosis of schizophrenia, living in the community, were interviewed using three questionnaires. The first related to demographics, the second used relevant parts of the Camberwell Assessment of Need (CAN) and the third looked at possible determinants of sexual behaviour. The CAN also captured keyworker responses to issues related to their clients sexual and relationship requirements. The results showed that 83% of the clients were currently experiencing sexual feelings. Some 90% of clients felt some need in relation to sexual expression and 83% for needs related to intimate relationships. Only 10% of staff recognized sexual expression as a need in clients in their care and 43% perceived a need for intimate relationships. Furthermore, most clients interviewed thought that their psychotropic medication caused sexual problems. Contrasts are made with other studies to help highlight the important issues that emerged for service users.

Self-reported needs among older persons with intellectual disabilities in an Irish community-based service

Current research indicates that older persons with intellectual disabilities (ID) are a growing population with very specific needs. There are few existing studies that identify and characterise these needs. This study aimed to assess the health and social care needs of a group of older persons with ID in a community-based service in Ireland. The Camberwell Assessment of Need for Adults with Intellectual Disabilities-Short form (CANDID-S) was used to identify the health and social needs of 75 older persons with ID in a community-based service who were over the age of 50. The mean age of the sample was 57.6 years ( SD = 5.4, range 50–72) and 37.3% had mild ID, 46.7% had moderate ID and 16% had severe or profound ID. The most common ‘unmet needs’ reported were basic education and money budgeting (the ability to independently manage one's own finances). The top-rated ‘met needs’ were food and daytime activities. Participants with severe or profound ID reported significantly more ‘unmet needs’ than those with mild or moderate ID. The current study identified education and financial skills as unmet needs for older persons with ID, implying that continuing lifelong learning programmes might be a valuable and appropriate addition to service provision and retirement options. Further research should be carried out to inform a comprehensive evidence base of the health and social care needs of this group.

Self-harm among UK female prisoners: a cross-sectional study

Psychiatric morbidity and suicide rates in prisoners are high. The detection of mental illness and its associated risks in prison are low. The aim of this study was to ascertain the prevalence of psychiatric symptomatology, needs and self-harming behaviour among UK female prisoners and to identify differences between individuals with and without a history of self-harm. We conducted a cross-sectional study including 638 female prisoners from two prisons in the North-West of England. Outcome measures used were the Prison Screening Questionnaire (PriSnQuest), a questionnaire on self-harming behaviour and suicidal ideation and the Camberwell Assessment of Need – Forensic Version (CANFOR). 241 women (37.8%) screened positive on the PriSnQuest; 281 women (45.9%) had a history of self-harm. An average of 8.5 needs was identified with more than half of those needs classified as unmet. Differences between women with and without history of self-harm were identified on offending history, PriSnQuest scores and the CANFOR total and unmet needs. Previous contact with a psychiatrist, total and symptoms of depression on the PriSnQuest were independently associated with a history of self-harm. This study confirmed that the prevalence of psychiatric symptomatology and self-harm in female UK prisoners is high. Individuals at risk of self-harming behaviour may be identified using screening questionnaires.

What do community-dwelling people with dementia need? A survey of those who are known to care and welfare services

The aging society will bring an increase in the number of people with dementia living in the community. This will mean a greater demand on care and welfare services to deliver efficient and customized care, which requires a thorough understanding of subjective and objective care needs. This study aims to assess the needs of community-dwelling people with dementia as reported by themselves and by their informal carers. The study also aims to give insight into the service use and gaps between needs and the availability of services. 236 community-dwelling people with dementia and 322 informal carers were interviewed separately. (Un)met needs were assessed using the Camberwell Assessment of Needs for the Elderly (CANE). Most unmet needs were experienced in the domains of memory, information, company, psychological distress and daytime activities. People with dementia reported fewer (unmet) needs than their carers. Type and severity of dementia, living situation and informal carer characteristics were related to the number of reported needs. This study showed a large number of unmet needs in dementia. Reasons for unmet needs are lack of knowledge about the existing service offer, a threshold to using services and insufficient services offer. These results provide a good starting point for improving community care for people with dementia.

Formal and informal support for older adults with severe mental illness

Objectives: This study sought to examine the combination of formal and informal services supplied to older adults with severe mental illness, to assess the adequacy of services received, and to determine factors predictive of formal and informal service provision. Methods: A cross-sectional research design was employed. Seventy-five older adults diagnosed with a SMI were recruited through local community mental health center. Data was collected through face-to-face interviews using the Camberwell Assessment of Needs for the Elderly. Results: Clients most frequently received services from formal sources for psychiatric distress, physical health, information, and dangerous behavior needs while informal sources provided the greatest amount of assistance for self-care, psychiatric distress, and money management needs. Appropriate assistance was most often not provided for benefits, sight/hearing, and incontinence. Formal services were predicted by group residence and dangerous behavior, physical illness, medication, and daily activity needs. Assistance from informal sources was predicted by private residence, self-care, mobility, and money management needs. Discussion: While formal and informal sources provided adequate services for certain client needs, over 70% of the clients did not receive the correct type of help for some of their needs. Greater communication between mental health care staff and informal caregivers, and the integration of aging network services, is essential for the adequate provision of care to older severely mentally ill (SMI) adults. Education and greater linkages among care providers are necessary so that all service providers are aware of and are able to appropriately respond to the complex multi-level needs experienced by older SMI adults.

The Met Needs Index: a new metric for outcome assessment in mental health services

No apt method has been available to assess and monitor the responsiveness of services in meeting ongoing needs of patients with long-term mental illness. The present study examines the utility of a new metric for such a purpose, the Met Needs Index (MNI), applied to the Camberwell Assessment of Need (CAN). The MNI was estimated as an aggregated measure of met need or beneficial outcome, based on annual staff rated CAN-assessments of 321 outpatients (76% psychotic disorders) in psychiatric care during 7 years. Corresponding confidence intervals were estimated with the bootstrap percentile method. The overall MNI was estimated at 0.71 (95% CI 0.69-0.74), indicating that identified needs in general were met during 71% of the intervals between the annual assessments. However, the MNI for specific need domains of the CAN ranged from 0.89 (95% CI 0.84-0.93) for 'food' to 0.11 (95% CI 0.07-0.16) for 'sexual expression', indicating a significant variation in responsiveness of services to different types of need in this patient population. The MNI seems to be a useful and powerful metric for outcome assessment and monitoring of psychiatric services from a needs assessment approach.

Self-assessment of need for help in patients undergoing psychiatric treatment

Needs assessment for patients in mental health care is an important tool. When used systematically, needs assessment can improve the quality of care and facilitate a process of ‘shared decision making’ in service provision. A self-report questionnaire, the Needs Assessment Scale (NAS), was developed for use in larger survey samples. The perceived problems of patients and their associated need for help were assessed in 22 life areas similar to those of the Camberwell Assessment of Need (CAN) interview. In this article, we explore the validity and utility of the NAS. For this purpose 305 psychiatric patients completed the NAS in a postal survey. The factor structure of the scale shows four subscales. Two domains are measured: problem assessment and needs assessment. Patients reported a mean number of 4.0 (S.D. 3.5) problem areas and a mean number of 2.4 (S.D. 3.6) unmet need areas. Differences between various subgroups (e.g. diagnostic categories, treatment setting) and concurrent validity with the CAN are discussed. The NAS seems to be sensitive to the perceived needs of patients, although those with psychotic disorders tend to under-report unmet need. We conclude that the NAS is a useful and feasible instrument in the assessment of patients' need for help at a population level.

Feasibility and reliability of the elderly version of the Camberwell Assessment of Needs (CANE): results from the São Paulo Ageing & Health Study

We set out to assess the feasibility, reliability and convergent validity of the Camberwell Assessment of Needs for the Elderly Scale in older residents of a Brazilian urban elderly population of low socioeconomic status. We identified 32 older users of community health services from a population-based catchment area survey. We administered the Brazilian version of the Camberwell Assessment of Needs for the Elderly Scale to the older person and to an informal caregiver, and tape-recorded the assessments. Interviewers made a rating. Tape-recordings were independently co-rated. Items contributing to older person and caregiver reports of needs and unmet needs had a high internal consistency. Inter-rater reliability was excellent for all needs, and fair to good for unmet needs. Older person and caregiver's reports, and interviewer ratings were highly mutually consistent. Convergent validity was supported by associations, as hypothesized, between needs and disability, and needs and dementia. The Brazilian version of the Camberwell Assessment of Needs for the Elderly Scale is a feasible, reliable and, to the extent assessed, valid assessment of unmet needs in a disadvantaged low and middle income countries setting. Its practical utility as a clinical tool remains to be assessed.

Treatment response in psychotic patients classified according to social and clinical needs, drug side effects, and previous treatment; a method to identify functional remission

Background Various approaches have been made over the years to classify psychotic patients according to inadequate treatment response, using terms such as treatment resistant or treatment refractory. Existing classifications have been criticized for overestimating positive symptoms; underestimating residual symptoms, negative symptoms, and side effects; or being to open for individual interpretation. The aim of this study was to present and evaluate a new method of classification according to treatment response and, thus, to identify patients in functional remission. Method A naturalistic, cross-sectional study was performed using patient interviews and information from patient files. The new classification method CANSEPT, which combines the Camberwell Assessment of Need rating scale, the Udvalg for Kliniske Undersøgelser side effect rating scale (SE), and the patient's previous treatment history (PT), was used to group the patients according to treatment response. CANSEPT was evaluated by comparison of expected and observed results. Results In the patient population (n = 123), the patients in functional remission, as defined by CANSEPT, had higher quality of life, fewer hospitalizations, fewer psychotic symptoms, and higher rate of workers than those with the worst treatment outcome. Conclusion In the evaluation, CANSEPT showed validity in discriminating the patients of interest and was well tolerated by the patients. CANSEPT could secure inclusion of correct patients in the clinic or in research.

P02-269 A new proposed protocol to evaluate anxiety, depression and the needs of cancer patients

Aims:To examine the perceived needs by patients and radiotherapists using a modified by us version of the Camberwell Assessment of Need (CAN).Methods:We eliminated 4/22 areas of the CAN scale -ideated for psychotic patients- in order to adapt it to oncological subjects (naming it CANo). Each of the scale areas values: the existence of a specific need; the help received from care-givers; the help coming from social services; the completeness of the help received. CANo was administrated to 30 solid cancer subjects consecutively admitted in 2007 to the Radiotherapy Department of Novara Hospital (Italy), and to their respective treating radiotherapists. Patients with cognitive impairment were excluded. Patients were also administrated the following protocol: HADS (Hospital anxiety and depression scale); Paykel's list of stressful events; MBTI (Mayer-Briggs Type Indicator); EORTC QLQ-C30.Results:Anxiety and depression occurred at any level in 15/30 of cases. There was a significant correlation (Spearman coefficient: SC) between the numbers of needs on CANo scale and anxiety (SC:0.4; p=0.002) or depression (SC:0.48; p=0.006) levels. Higher scores in all functional EORTC scales corresponded to lower needs detected by CANo. Patient needs were perceived less important by patients themselves than their physicians (mean satisfied need scores: 1.87 vs. 3; unsatisfied need scores: 0.63 vs. 1.03). The staff overestimated patient physical health needs (7/30 vs 3/30), psychological distress (20/30 vs 5/30), relationship difficulties (9/30 vs 2/30), received information correctness (7/30 vs 2/30).Conclusions:The CANo scale may be useful to detect oncological patient needs and to improve the quality of care.

The Camberwell Elderly Mentally Ill and Their Needs for Services

Previous studies on the elderly mentally ill (graduates) have been undertaken in mental hospital settings and on populations being resettled from hospitals. This paper aims to assess the characteristics and service needs of an epidemiological sample of elderly mentally ill. The aim of this study was to identify the characteristics, problems, service utilization and needs of a sample of elderly patients with functional psychosis in a defined epidemiological area. Data collected by PRiSM on psychotic patients who lived in two districts of Maudsley Hospital's catchment area were analyzed using the characteristics, problems and the needs for mental health services of those patients who were over the age of 64. These patients were compared with younger patients using the same data. The elderly patients differed significantly in their characteristics and problems from the younger mentally ill persons. The needs assessment procedure (Camberwell Assessment of Needs, CAN) was less sensitive to physical and psychiatric needs of the elderly as it did not reflect the differences between the two age groups. The lower rate of schizophrenia in the elderly mentally ill compared to the younger community patients and asylum mentally ill is discussed. The explanation may lie in the natural history of the disorder or more plausibly in the implementation of ;community care policy'. The paper concluded that a needs assessment procedure specifically designed to assess the needs of the elderly is required.

Validation study of the Camberwell Assessment of Need for the Elderly (CANE) in Portugal

The Camberwell Assessment of Need for the Elderly (CANE) is widely used for multidimensional evaluation of older people with mental health problems. The aim of this study was to evaluate reliability and validity of a Portuguese version of CANE. A cross-sectional multicenter study was designed using a convenience sample of elderly mental health services' users. CANE was compared with EASYCare, GHQ12, MMSE, Barthel Index and GDS15 to assess criterion and construct validity. Inter-rater and test-retest reliability were also assessed. 79 patients (76% female), with mean age of 74 (+/- 6.6) years were included. Most patients lived at home with a family caregiver, generally female. Only 32% had no carer. Dementia was the commonest psychiatric diagnosis (61%) and somatic comorbidity was very prevalent (85%). Kappa values (kappa) for inter-rater item reliability ranged from 0.72 to 1.00 (mean values: 0.96 patient, 0.93 carer, 0.90 staff). The intraclass correlation coefficient (ICC) for total scores ranged from 0.95 to 0.98.For test-retest item reliability, the mean kappa value was: 0.80 patient, 0.77 carer, 0.81 staff. ICC for total scores ranged from 0.82 to 0.92. Given the absence of a gold standard, criterion validity was assessed by comparing CANE with EASYCare (rs 0.460; p < or = 0.01), GDS (rs 0.615; p < or = 0.01), GHQ (rs 0.581; p < or = 0.01) and Barthel Index (rs-0.435; p < or = 0.01). Overall, inter-item and item-total correlations for CANE and item comparison with other measures indicated reasonable construct validity. The psychometric proprieties of CANE seem to be consistently good, in accordance with other studies. Robust results on ecological, face, content, criterion and construct validity, as well as good reliability, were achieved. This version is a promising tool for research and practical use in Portuguese old age settings.

Social Functioning of Patients With Personality Disorder in Secondary Care

Social Functioning of Patients With Personality Disorder in Secondary Care

Social Functioning of Patients With Personality Disorder in Secondary Care

Patients with personality disorder are often viewed as falling outside the primary therapeutic role of specialist care. This focus on axis I disorders can lead to overlooking patients' personality function. This study explored the social dysfunction associated with personality function and its severity within secondary care. A cross-sectional survey using census data, face-to-face interviews, and audit of case notes was used to collect information from secondary care populations in four urban settings in the United Kingdom. The Quick Personality Assessment Schedule, the Comprehensive Psychopathology Rating Scale, and operational criteria for diagnosis were used to confirm axis I and axis II disorders. Social functioning was assessed with the Camberwell Assessment of Need and the Social Functioning Questionnaire. Because this was a secondary analysis, a priori hypotheses were tested to the p=.01 level to minimize the possibility of type I error. A total of 2,528 key workers completed questionnaires (99%), and 282 randomly selected patients were interviewed (71%). Severity of personality disorder accounted for 14% of the variance in objective measure of social dysfunction and for 19% of the variance in subjective measure of social dysfunction. Of other mental disorders, only depression interacted significantly with either measure, according to multiple stepwise linear regression. Personality disturbance led to social dysfunction to a greater extent than most other pathology. In order to address the issue of social dysfunction, a variety of approaches are needed to turnattention toward personality pathology.

An Observational Study of the Needs and Quality of Life Amongst Patients in the Treatment of Alzheimers Dementia with Cholinesterase Inhibitors

Alzheimer's dementia is one of the most commost mental health disorders associated with aging. In its earlier stages sufferers live independently but gradually rely increasingly on loved ones or formal carers for support as the illness progresses. Its treatment involves both medical and social care. This study assesses the impact of outpatients' care and cholinesterase inhibitors in patients being treated for Alzheimer's dementia. The needs and quality of life of patients attending an outpatients dementia care service were assessed using the Camberwell Assessment of Need for the Elderly (CANE) and Quality of Life in Alzheimer's Disease: Patient and Caregiver report. Other tools used were the Problems Checklist and Carer Strain, the Minimental State Examination (MMSE) and a proforma to obtain sociodemographic details. All patients who had informal care were assessed using the questionnaires. 104 patients were seen of whom 34 were new and 70 were follow-up patients. 43 patients lived alone while the rest lived with their spouses or other relatives such as children. There was reduction in the number of CANE unmet needs and increased combined Quality of Life in Alzheimer's Dementia scores in the first three months amongst the newly referred patients. The findings suggest that outpatients' dementia care and prescribing of cholinesterase inhibitors helped to meet the needs of patients and improve patients' quality of life in first three months.

The Camberwell Assessment of Need rating scales

The Camberwell Assessment of Need rating scales

Validity and reliability of the Dutch version of the Camberwell Assessment of Need for the Elderly in community-dwelling people with dementia

Tailor-made care in dementia requires an individual needs assessment. The Camberwell Assessment of Need for the Elderly (CANE) was developed to assess needs of older people with mental disorders. In this study the validity and reliability of the Dutch version of the CANE were studied among community-dwelling persons with dementia and their informal carers. Interviews were carried out with 236 people with mild to severe dementia and 322 informal carers; 69 informal carers were interviewed twice. Construct and criterion validity and test-retest reliability of the CANE were studied using data for informal carers. Construct validity was also studied for CANE ratings of people with dementia. The construct validity of the CANE was good among people with dementia and informal carers. Criterion validity could be studied for 76.9% of the CANE items, and all significant correlations were convergent. Test-retest reliability of the CANE varied from poor to very good and was best on domains where needs were explicit and problems well defined. Use of the Dutch version of the CANE among community-dwelling people with dementia and their carers is supported by the study results, with the study showing acceptable construct and criterion validity and test-retest reliability of the CANE.

The needs of mothers with severe mental illness: a comparison of assessments of needs by staff and patients

To identify the concordance in assessments of health and social care needs of pregnant women and mothers with severe mental illness as assessed by patients themselves and their mental healthcare professionals. Thirty-five staff-patient pairs were recruited from inpatient and community services. Staff and patients completed the Camberwell Assessment of Need--Mothers Version. There were significant differences in the total number of needs (p < 0.01) and total number of unmet needs (p < 0.001) reported by staff and patients themselves. There was moderate or better agreement on the presence of an unmet need in eight of 26 life domains. Agreement was low in several domains relevant to being a mother--notably pregnancy care, safety to child/others, and practical and emotional childcare domains. Unmet needs were particularly common in the areas of daytime activities, sleep, psychological distress and violence and abuse. Staff and pregnant women and mothers with severe mental illness moderately agree about health and social care needs but agree less often on which needs are unmet. This highlights the importance of the views of the mothers themselves, as well as assessments by staff.